Doctor Name: | MRS. NEICOLE DUTTON BLACK |
NPI Number: | 1033158548 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | 1091 |
Business Practice Address: | 1212 S Walnut St Fairmont, NC - 283401848 |
Business Phone Number: | 9106286711 |
Business Fax Number: | 9106285735 |
Mailing Address: | 60 Commerce Plaza Cir, PEMBROKE |
State: | NC |
Postal Code: | 283727386 |
Phone Number: | 9105212900 |
Fax Number: | 9107759165 |
NPI Enumeration Date: | 06/06/2006 |
NPI Last Update Date: | 07/26/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 1091 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | SC |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |