Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 930054 | NC |
NPI | 1003889965 |
---|---|
Provider Name | Mrs. Paula Beth Roach |
First Address | Lumberton, NC 28358-2405 |
Second Address | Fort Bragg, NC 28310-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2006 |
Last Update Date | 08/07/2007 |