Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 224P00000X | Prosthetist | C84039 | NC |
NPI | 1295382158 |
---|---|
Provider Name | Mrs. Sadequa Jones-Mcqueen |
First Address | Sanford, NC 27330-7309 |
Second Address | Sanford, NC 27330-7309 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2019 |
Last Update Date | 23/08/2019 |