Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 049064 | NC |
NPI | 1003208349 |
---|---|
Provider Name | Marva Price |
First Address | Pittsboro, NC 27312-8559 |
Second Address | Asheboro, NC 27205 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2015 |
Last Update Date | 24/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1720011729 | (05) | NC |