Registry details
Type
Individual
Primary specialty
Nurse Practitioner
Enumerated
Mar 2, 2020
License(s)
5012902 (NC)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 1001 BLYTHE BLVD STE 500 | Charlotte, NC 28203-5866 | 704-373-1813 |
| MAILING | PO BOX 19305 | Charlotte, NC 28219-9305 |
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