Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | DMYT-D80B68 | NC |
NPI | 1346760675 |
---|---|
Provider Name | Mrs. Trisha Ann Dmytruk |
First Address | Huntersville, NC 28078-3753 |
Second Address | Charlotte, NC 28277-4821 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2017 |
Last Update Date | 16/06/2018 |