Registry details
Type
Individual
Primary specialty
Nurse Practitioner
Enumerated
Nov 9, 2005
License(s)
0024000002 (VA), 201100 (NC)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 111 COMER ST | Dobson, NC 27017-8804 | 363-864-4523 |
| MAILING | 100 KIMEL FOREST DR | Winston Salem, NC 27103-6074 | 336-716-1331 |
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