Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 666 | NC |
NPI | 1033629118 |
---|---|
Provider Name | Stacie Diette |
First Address | Raleigh, NC 27617-8321 |
Second Address | Durham, NC 27704-2702 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2017 |
Last Update Date | 17/03/2018 |