Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 131664 | NC |
NPI | 1073057329 |
---|---|
Provider Name | Mr. Steven Angelos Marinos |
First Address | Clayton, NC 27520-8719 |
Second Address | Clayton, NC 27520-8719 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2016 |
Last Update Date | 06/12/2016 |