Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | CO03395 | NC |
Y | 222Z00000X | Podiatrist | CO03395 | NC |
N | 225000000X | Orthotic Fitter | CFOM0085 | NC |
NPI | 1730298357 |
---|---|
Provider Name | Mrs. Rebecca Anne Coates |
First Address | Spring Lake, NC 28390-7637 |
Second Address | Fayetteville, NC 28314-2572 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 07/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7795105 | (05) | NC |
7795188 | (05) | NC |