Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 5015040 | NC |
NPI | 1154091205 |
---|---|
Provider Name | Nadiya Fernandivna Marrengulye |
First Address | Asheville, NC 28804-1365 |
Second Address | Asheville, NC 28801-1218 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2021 |
Last Update Date | 20/09/2021 |