Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 137721 | NC |
NPI | 1073663506 |
---|---|
Provider Name | Mary Kay Hostetler |
First Address | Greenville, NC 27858-5455 |
Second Address | Greenville, NC 27834-2818 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NNP | LICENSE (01) | NC |