Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207SG0201X | Clinical Genetics (M.D.) | 36251 | NC |
Y | 208000000X | Pediatrician | 36251 | NC |
NPI | 1013911494 |
---|---|
Provider Name | Pamela Jean Reitnauer |
First Address | Greensboro, NC 27401-1004 |
Second Address | Greensboro, NC 27401-1004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2005 |
Last Update Date | 27/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
36251 | NC LICENSE (01) | NC |
8971218 | (05) | NC |
B53628311 | DEA # (01) | NC |