Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 28956 | NC |
N | 2080N0001X | Neonatal-Perinatal Doctor | 28956 | NC |
NPI | 1093709701 |
---|---|
Provider Name | Susan L Church |
First Address | Rocky Mount, NC 27804-1400 |
Second Address | Rocky Mount, NC 27804-1400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2005 |
Last Update Date | 22/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1521919 | CIGNA HEALTHCARE (01) | NC |
22480 | BCBSNC (01) | NC |
69963 | MEDCOST (01) | NC |
7922480 | (05) | NC |
F87948 | (02) | NC |