Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 200500137 | NC |
NPI | 1295409035 |
---|---|
Provider Name | Mrs. Mary Margaret Rockers Tyni |
First Address | Cary, NC 27518-7084 |
Second Address | Cary, NC 27518-7084 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2021 |
Last Update Date | 05/08/2021 |