Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 5009657 | NC |
NPI | 1063910503 |
---|---|
Provider Name | Mrs. Alexandra Kesler Johnson |
First Address | Charlotte, NC 28260-3949 |
Second Address | Cary, NC 27518-6616 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2018 |
Last Update Date | 23/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1063910503 | (05) | NC |