Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 5005892 | NC |
NPI | 1164775888 |
---|---|
Provider Name | Jennifer Reynolds Parrotte |
First Address | Wilmington, NC 28401-7307 |
Second Address | Wilmington, NC 28401-7307 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2012 |
Last Update Date | 30/10/2014 |