Individual
TIARA FETHERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CERTIFIED HAIR LOSS
Contact information
Practice address
2516 REYNOLDA RD, WINSTON SALEM, NC 27106-4618
(980) 230-4841
Mailing address
2516 REYNOLDA RD, WINSTON SALEM, NC 27106-4618
(980) 230-4841
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
C92097
NC
Other
Enumeration date
04/11/2021
Last updated
04/11/2021
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