Provider Demographics
NPI:1548513070
Name:SEVILLA-BINGEMER, IRENE FAITH (10461)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:FAITH
Last Name:SEVILLA-BINGEMER
Suffix:
Gender:F
Credentials:10461
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 GRAYSTAR RD
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-6424
Mailing Address - Country:US
Mailing Address - Phone:602-690-3276
Mailing Address - Fax:
Practice Address - Street 1:114 SALEM TOWNE CT
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-2311
Practice Address - Country:US
Practice Address - Phone:919-655-4384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10461225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist