Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225000000X | Orthotic Fitter | 9579 | NC |
NPI | 1659572212 |
---|---|
Provider Name | Ms. Paulette Jackson |
First Address | Lewiston, NC 27849 |
Second Address | Lewiston, NC 27849 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2007 |
Last Update Date | 20/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7490010 | (05) | NC |
7795134 | (05) | NC |