Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 165 | NC |
NPI | 1114099041 |
---|---|
Provider Name | Ms. Vicki Legrand Latham |
First Address | Greensboro, NC 27408-7600 |
Second Address | Greensboro, NC 27408-7600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2006 |
Last Update Date | 10/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7821 | ACNM CERTIFICATE NUMBER (01) | NC |