Registry details
Type
Individual
Primary specialty
Nurse Practitioner, Family
Enumerated
May 1, 2023
License(s)
5021426 (NC), 5021426 (NC), 26NJ01388800 (NJ)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 909 RIDGEBROOK RD STE 300 | Sparks, MD 21152-9477 | 443-383-9300 |
| LOCATION | 6047 TYVOLA GLEN CIR STE 100 | Charlotte, NC 28217-6431 | 443-383-9300 |
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