Healthcare Provider Details

I. General information

NPI: 1487313771
Provider Name (Legal Business Name): NATHALIE MARIE ESPINA BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2021
Last Update Date: 12/14/2021
Certification Date: 12/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 N PEACE HAVEN RD STE 104
WINSTON SALEM NC
27106-4850
US

IV. Provider business mailing address

1959 N PEACE HAVEN RD STE 104
WINSTON SALEM NC
27106-4850
US

V. Phone/Fax

Practice location:
  • Phone: 336-560-7878
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: