Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | 2019-01754 | NC |
Y | 208000000X | Pediatrician | 2019-01754 | NC |
NPI | 1376907287 |
---|---|
Provider Name | Rebekah Jewell |
First Address | Winston Salem, NC 27157-0001 |
Second Address | Winston Salem, NC 27157-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2016 |
Last Update Date | 11/08/2021 |