Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service |
NPI | 1295306421 |
---|---|
Provider Name | Jennifer Reeder Matthews |
First Address | Fuquay Varina, NC 27526-6949 |
Second Address | Cary, NC 27511-4574 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2021 |
Last Update Date | 08/07/2021 |