Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 5006795 | NC |
N | 363LN0000X | Nurse Practitioner - Neonatal | DELO-11P1TM | NC |
NPI | 1174949812 |
---|---|
Provider Name | Mrs. Kristina Brown Deloache |
First Address | Chapel Hill, NC 27599-7596 |
Second Address | Chapel Hill, NC 27599-7596 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2014 |
Last Update Date | 06/03/2014 |