Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 203 | NC |
Y | 222Z00000X | Podiatrist | 203 | NC |
N | 213ES0103X | Foot & Ankle Surgery | 203 | NC |
N | 213ES0131X | Foot Surgery | 203 | NC |
NPI | 1295739019 |
---|---|
Provider Name | Terry Ann Donovan |
First Address | Clemmons, NC 27012-0268 |
Second Address | Clemmons, NC 27012-9380 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2005 |
Last Update Date | 01/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
561696265 | COMMERCIAL (01) | |
8908053 | (05) | NC |
NC2383B699 | (02) | NC |
T64102 | (02) |