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Physician Assistants & Advanced Practice Nursing Providers Physician Assistant Surgical

Provider NPI: 1811321581

Provider Information:
Gender: F
Not Sole Proprietor

Practice Location:
Tel: 843-792-1414  Fax: --

Business Mailing Address:
PO BOX 751461  CHARLOTTE, NC 28275-1461 US
Tel: 843-792-6200  Fax: --

NPI Information:
NPI: 1811321581
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y363AS0400XPhysician Assistants & Advanced Practice Nursing Providers
Physician Assistant

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 363AS0400X





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