Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 5009760 | NC |
NPI | 1003327461 |
---|---|
Provider Name | Dr. Joshua Dean Mcconaghay |
First Address | Raleigh, NC 27610-2593 |
Second Address | Raleigh, NC 27610-2593 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2017 |
Last Update Date | 12/10/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5009760 | STATE LICENSE NUMBER (01) | NC |