Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 200600938 | NC |
Y | 2080P0202X | Pediatric Cardiologist | 2006-00938 | NC |
NPI | 1104974526 |
---|---|
Provider Name | Stacey E Applegate |
First Address | Charlotte, NC 28275-1069 |
Second Address | Greenville, NC 27834-8982 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 09/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
165F6 | BCBSNC (01) | NC |
5918594 | (05) | NC |