Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1780984799 |
---|---|
Provider Name | Nancy Bumgarner Watson |
First Address | North Wilkesboro, NC 28659-3563 |
Second Address | North Wilkesboro, NC 28659-3563 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2010 |
Last Update Date | 25/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0975432 | (05) | NC |