Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 5003940 | NC |
NPI | 1346411014 |
---|---|
Provider Name | Alythia Monique Carlson Alcorn |
First Address | Winston Salem, NC 27103-5616 |
Second Address | Winston Salem, NC 27103-3013 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2008 |
Last Update Date | 25/10/2020 |