Registry details
Type
Individual
Primary specialty
Nurse Practitioner
Enumerated
Aug 17, 2005
License(s)
21739 (SC), 5010396 (NC)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 1021 MOREHEAD MEDICAL DR STE A | Charlotte, NC 28204-2990 | 980-442-2000 |
| MAILING | PO BOX 19305 | Charlotte, NC 28219-9305 |
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