Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 2014-02254 | NC |
N | 207V00000X | Obstetrician & Gynecologist | 40587 | SC |
Y | 207VX0201X | Gynecologic Oncologist | 2014-02254 | NC |
NPI | 1093079634 |
---|---|
Provider Name | Laurel Katherine Berry |
First Address | Charlotte, NC 28275-1461 |
Second Address | Winston Salem, NC 27157-2868 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2012 |
Last Update Date | 13/08/2019 |