Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 2003-00528 | NC |
NPI | 1144289778 |
---|---|
Provider Name | Joan Shen |
First Address | Charlotte, NC 28275-1803 |
Second Address | Winston Salem, NC 27103-1508 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2006 |
Last Update Date | 27/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2024165A | (02) | NC |
89135TT | (05) | NC |
F17373 | (02) | NC |