Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 693 | NC |
NPI | 1023176096 |
---|---|
Provider Name | Mrs. Kathryn Brown Cordle |
First Address | Wilmington, NC 28411-9384 |
Second Address | Wilmington, NC 28411-9384 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2006 |
Last Update Date | 25/02/2008 |