Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 5009191 | NC |
NPI | 1558807511 |
---|---|
Provider Name | Mary Jane Woods |
First Address | Fuquay Varina, NC 27526-6986 |
Second Address | Fayetteville, NC 28304-3424 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2017 |
Last Update Date | 16/01/2017 |