Registry details
Type
Individual
Primary specialty
Nurse Practitioner, Family
Enumerated
Aug 9, 2021
License(s)
5016884 (NC), 5016884 (NC)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 1350 S KINGS DR | Charlotte, NC 28207-2134 | 704-446-1255 |
| MAILING | PO BOX 19305 | Charlotte, NC 28219-9305 |
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