Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 200400405 | NC |
N | 207QS0010X | Family Doctor - Sports Medicine | 2004-00405 | NC |
NPI | 1205937992 |
---|---|
Provider Name | Noelle Celine Robertson |
First Address | Morrisville, NC 27560-8442 |
Second Address | Cary, NC 27519-8969 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 10/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5904811 | (05) | NC |
I40170 | (02) |