Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 5008799 | NC |
N | 363LA2200X | Nurse Practitioner - Adult Health | R197383 | MD |
N | 363LG0600X | Nurse Practitioner - Gerontology | R197383 | MD |
NPI | 1073957205 |
---|---|
Provider Name | Gabrielle Picard |
First Address | Raleigh, NC 27617-5963 |
Second Address | Charlotte, NC 28273-6230 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2013 |
Last Update Date | 11/08/2016 |