Provider Demographics
NPI:1861070740
Name:DRUMMOND, NOAH LEE JR
Entity type:Individual
Prefix:
First Name:NOAH
Middle Name:LEE
Last Name:DRUMMOND
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 GWENDOLYN WAY
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-4285
Mailing Address - Country:US
Mailing Address - Phone:609-850-9080
Mailing Address - Fax:
Practice Address - Street 1:129 GWENDOLYN WAY
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-4285
Practice Address - Country:US
Practice Address - Phone:609-850-9080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC000046825640225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist