Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 2018-01211 | NC |
NPI | 1134513583 |
---|---|
Provider Name | Mary Devane |
First Address | Charlotte, NC 28219-9305 |
Second Address | Charlotte, NC 28262-3485 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2015 |
Last Update Date | 20/01/2021 |