Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225000000X | Orthotic Fitter | 23483 | NC |
NPI | 1164488755 |
---|---|
Provider Name | Katherine R Stanley |
First Address | Winston Salem, NC 27103-4114 |
Second Address | Winston Salem, NC 27103-4114 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2006 |
Last Update Date | 15/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7701864 | (05) | NC |