Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 5007728 | NC |
NPI | 1003299561 |
---|---|
Provider Name | Mrs. Chrishaunda Lakeish Vick |
First Address | Morrisville, NC 27560-8442 |
Second Address | Raleigh, NC 27610-1551 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2015 |
Last Update Date | 20/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MV3559525 | DEA (01) | NC |