Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist | NC |
NPI | 1033870571 |
---|---|
Provider Name | Tiffany Nicole Tucker Oldham |
First Address | Goldston, NC 27252-0261 |
Second Address | Sanford, NC 27330-5066 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2022 |
Last Update Date | 25/01/2022 |