Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 200577 | NC |
NPI | 1013026152 |
---|---|
Provider Name | Ellen Price |
First Address | Charlotte, NC 28219-9305 |
Second Address | Charlotte, NC 28203-5866 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 20/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P20154 | (02) |