Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 5008952 | NC |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 5008952 | NC |
NPI | 1003362765 |
---|---|
Provider Name | Mrs. Amanda D Marshburn |
First Address | Kinston, NC 28501-1589 |
Second Address | Richlands, NC 28574-7198 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2016 |
Last Update Date | 10/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201339 | NCBON (01) | NC |
5008952 | NCBON NP (01) | NC |