Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 5008488 | NC |
NPI | 1003270042 |
---|---|
Provider Name | Jordan Mckenzie-Solis |
First Address | Greenville, NC 27858-9011 |
Second Address | Greenville, NC 27834-2818 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2016 |
Last Update Date | 07/05/2016 |