Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 2013-00503 | NC |
NPI | 1174888093 |
---|---|
Provider Name | Lyndsay Isil Weyers |
First Address | Raleigh, NC 27607-6678 |
Second Address | Raleigh, NC 27607-6678 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2012 |
Last Update Date | 15/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2013-00503 | NORTH CAROLINA MEDICAL BOARD LICENSE (01) | NC |