Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 5006475 | NC |
NPI | 1033546494 |
---|---|
Provider Name | Jamison Lord |
First Address | Haw River, NC 27258-9596 |
Second Address | Greensboro, NC 27403-1128 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2013 |
Last Update Date | 01/10/2013 |