Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 005000027 | NC |
NPI | 1013942762 |
---|---|
Provider Name | Mary W Larach |
First Address | Greensboro, NC 27405-4522 |
Second Address | Greensboro, NC 27405-4522 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 28/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7003698 | (05) | NC |
Q42516 | (02) |