Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 5008645 | NC |
NPI | 1003277948 |
---|---|
Provider Name | Crystal Lublin |
First Address | Hampstead, NC 28443 |
Second Address | Hampstead, NC 28443-5260 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2016 |
Last Update Date | 26/07/2016 |