Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 32508 | NC |
Y | 207V00000X | Obstetrician & Gynecologist | 32508 | NC |
N | 207VG0400X | Gynecologist | 32508 | NC |
NPI | 1033105291 |
---|---|
Provider Name | Mary Boggs Lane |
First Address | Murphy, NC 28906-2814 |
Second Address | Murphy, NC 28906-2814 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2005 |
Last Update Date | 23/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
890288N | (05) | NC |
C84359 | (02) | NC |