Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC1500X | Nurse Practitioner - Community Health | 256399 | NC |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 256399 | NC |
N | 363LX0106X | Nurse Practitioner - Occupational Health | 256399 | NC |
NPI | 1306481114 |
---|---|
Provider Name | Nicole Dominique Calhoun |
First Address | Winston Salem, NC 27107-6550 |
Second Address | Winston Salem, NC 27107-6550 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2019 |
Last Update Date | 15/11/2019 |