Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 5009951 | NC |
NPI | 1013427483 |
---|---|
Provider Name | Ms. Angela N Dvorak De Morales |
First Address | Raleigh, NC 27613-3518 |
Second Address | Durham, NC 27705-4699 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2017 |
Last Update Date | 11/10/2017 |