Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 201801455 | NC |
NPI | 1023286861 |
---|---|
Provider Name | Mrs. Tracy A Novosel |
First Address | Wilmington, NC 28405-3161 |
Second Address | Wilmington, NC 28405 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2008 |
Last Update Date | 21/06/2018 |