Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 2000288002 | NC |
NPI | 1003407966 |
---|---|
Provider Name | Brandy Watts Matheson |
First Address | Evergreen, NC 28438-9024 |
Second Address | Evergreen, NC 28438-9024 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2021 |
Last Update Date | 02/02/2021 |