Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | CFO02449 | NC |
NPI | 1457551178 |
---|---|
Provider Name | Rhonda Ingram |
First Address | Concord, NC 28025-2404 |
Second Address | Salisbury, NC 28147-1317 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2007 |
Last Update Date | 12/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7795100 | (05) | NC |