Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 5013192 | NC |
NPI | 1003431776 |
---|---|
Provider Name | Marnie Anderson |
First Address | Hickory, NC 28603-3710 |
Second Address | Hickory, NC 28602-4031 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2020 |
Last Update Date | 18/03/2021 |