Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | 0010-05730 | NC |
NPI | 1154708402 |
---|---|
Provider Name | Mrs. Katherine Mcdougal |
First Address | Raleigh, NC 27610-1827 |
Second Address | Raleigh, NC 27610-1827 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2015 |
Last Update Date | 27/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1154708402 | (05) | NC |