Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 2012-02406 | NC |
NPI | 1033346176 |
---|---|
Provider Name | Judit Andrea Staneata |
First Address | Fayetteville, NC 28314-2572 |
Second Address | Fayetteville, NC 28314-2572 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2009 |
Last Update Date | 20/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201202406 | (05) | NC |
2012-02406 | (05) | NC |
2012-02406 | NC LICENSE (01) | NC |