Basic Information
| Provider Information | |||||||||
| NPI: | 1891956322 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NEUTZE | ||||||||
| FirstName: | DANA | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 590 MANNING DR | ||||||||
| Address2: | CB 7586 | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275996119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199660210 | ||||||||
| FaxNumber: | 9199666126 | ||||||||
| Practice Location | |||||||||
| Address1: | 590 MANNING DR | ||||||||
| Address2: | CB 7586 | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275996119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199660210 | ||||||||
| FaxNumber: | 9199666216 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2008 | ||||||||
| LastUpdateDate: | 03/31/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 149966 | NC | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 2011-00260 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.