Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 5008828 | NC |
NPI | 1003361106 |
---|---|
Provider Name | Priscila M Tomlin |
First Address | Durham, NC 27713-6347 |
Second Address | Durham, NC 27713-6347 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2016 |
Last Update Date | 18/08/2016 |