Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | R212310 | MD |
Y | 363LP2300X | Nurse Practitioner - Primary Care | R212310 | MD |
NPI | 1063015931 |
---|---|
Provider Name | Paulina Nguyo |
First Address | Salisbury, MD 21801 |
Second Address | Pocomoke City, MD 21851-1714 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2020 |
Last Update Date | 01/08/2021 |