Individual
WINE NGON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4149 LAKE LYNN DR APT 107, RALEIGH, NC 27613-3453
(910) 729-3005
Mailing address
4149 LAKE LYNN DR APT 107, RALEIGH, NC 27613-3453
(910) 729-3005
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
18856
NC
Other
Enumeration date
09/30/2020
Last updated
09/30/2020
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