Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 5010294 | NC |
NPI | 1023518339 |
---|---|
Provider Name | Henry Matthew Vanpala |
First Address | Raleigh, NC 27609-1300 |
Second Address | Raleigh, NC 27609-1300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2018 |
Last Update Date | 14/02/2018 |