Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 2016-00763 | NC |
NPI | 1245599273 |
---|---|
Provider Name | Jessica Son |
First Address | Raleigh, NC 27615-2944 |
Second Address | Winston Salem, NC 27103-1955 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2012 |
Last Update Date | 31/08/2016 |