Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 5013687 | NC |
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 5013687 | NC |
NPI | 1265032536 |
---|---|
Provider Name | Mrs. Heidi Ellen Jumbercotta |
First Address | Wilmington, NC 28403-1136 |
Second Address | Fayetteville, NC 28304-3424 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2020 |
Last Update Date | 02/02/2021 |