Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | LAT-2513 | NC |
Y | 213ES0000X | Sports Medicine | LAT-2513 | NC |
NPI | 1497142566 |
---|---|
Provider Name | Ruth Fuqua |
First Address | Chapel Hill, NC 27516-2536 |
Second Address | Chapel Hill, NC 27516-2536 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2015 |
Last Update Date | 16/04/2015 |