Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 5006715 | NC |
NPI | 1003230483 |
---|---|
Provider Name | Heather Mcphail Maynor |
First Address | Fayetteville, NC 28304-3424 |
Second Address | Fayetteville, NC 28304-3424 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2014 |
Last Update Date | 06/02/2014 |