Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 2007-00436 | NC |
N | 208000000X | Pediatrician | 1385TEP | WI |
N | 208000000X | Pediatrician | 200700436 | NC |
NPI | 1619932746 |
---|---|
Provider Name | Joanna E York |
First Address | Charlotte, NC 28207-1117 |
Second Address | Charlotte, NC 28207-1117 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2006 |
Last Update Date | 27/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
59-09804 | (05) | NC |
N0043C | (05) | SC |
P00636539 | RR MEDICARE (01) | NC |