Registry details
Type
Individual
Primary specialty
Nurse Practitioner, Family
Enumerated
Nov 30, 2017
License(s)
5013411 (NC)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 245 E ROOSEVELT AVE | Wake Forest, NC 27587-2719 | |
| LOCATION | 245 E ROOSEVELT AVE | Wake Forest, NC 27587-2719 | 866-389-2727 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.