Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 5000950 | NC |
Y | 363LG0600X | Nurse Practitioner - Gerontology | 5000950 | NC |
NPI | 1063468601 |
---|---|
Provider Name | Cynthia Brantley |
First Address | Asheville, NC 28801-4160 |
Second Address | Asheville, NC 28801-4160 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2006 |
Last Update Date | 07/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1063468601 | (05) | NC |
1604W | BCBSNC (01) | NC |