Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 5014531 | NC |
NPI | 1124697206 |
---|---|
Provider Name | Amanda L Shirley |
First Address | Wilmington, NC 28401-6605 |
Second Address | Southport, NC 28461-9730 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2021 |
Last Update Date | 22/06/2021 |