Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 5010189 | NC |
NPI | 1033627450 |
---|---|
Provider Name | Nicole Majette Enyinnaya |
First Address | Wilson, NC 27893-4105 |
Second Address | Wilson, NC 27893-4105 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2018 |
Last Update Date | 19/01/2018 |