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Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Psychiatric/Mental Health

Provider NPI: 1003374208

Provider Information:
Gender: F
Sole Proprietor

Practice Location:
3640 EXPRESS DR  SHALLOTTE, NC 28470-6501 US
Tel: 910-755-5222  Fax: --

Business Mailing Address:
PO BOX 1585  SHALLOTTE, NC 28459-1585 US
Tel: 910-755-5222  Fax: --

NPI Information:
NPI: 1003374208
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y363LP0808XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner
Psychiatric/Mental Health

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 363LP0808X





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