Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 5010751 | NC |
NPI | 1023591807 |
---|---|
Provider Name | Jill Mcdaniel |
First Address | Greensboro, NC 27408-6819 |
Second Address | Greensboro, NC 27401-1000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2018 |
Last Update Date | 25/08/2021 |