Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 6172 | NC |
NPI | 1588827257 |
---|---|
Provider Name | Pamela Rouse |
First Address | Raleigh, NC 27629-0881 |
Second Address | Bunn, NC 27508 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2008 |
Last Update Date | 03/07/2008 |