Provider Demographics
NPI:1124898465
Name:RODDICK, NYQUITA
Entity type:Individual
Prefix:
First Name:NYQUITA
Middle Name:
Last Name:RODDICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 PATETOWN RD STE 14
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-5570
Mailing Address - Country:US
Mailing Address - Phone:919-910-0186
Mailing Address - Fax:
Practice Address - Street 1:501 PATETOWN RD STE 14
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-5570
Practice Address - Country:US
Practice Address - Phone:919-910-0186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC429113376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide