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Individual
NIPA DANI
Active
Individual
NIPA DANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
2009-01410
NC
207Q00000X
Family Medicine Physician
Primary
25MA12968200
NJ
207Q00000X
Family Medicine Physician
4301078535
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013997212
—
NC
05
—
4891230
—
MI
05
—
5913078
—
NC
05
—
NC1032
—
SC
Enumeration date
01/23/2006
Last updated
02/04/2026
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