Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | ||
N | 225000000X | Orthotic Fitter | CFO04639 | NC |
NPI | 1356546089 |
---|---|
Provider Name | Mrs. Cynthia Monroe |
First Address | Jacksonville, NC 28546-6042 |
Second Address | Jacksonville, NC 28546-6042 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2007 |
Last Update Date | 09/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1356546089 | (05) | NC |
7795158 | (05) | NC |