Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 5011811 | NC |
N | 363LP2300X | Nurse Practitioner - Primary Care | RUI71R | NC |
NPI | 1023671070 |
---|---|
Provider Name | Mrs. Jennifer Leigh Cook |
First Address | Charlotte, NC 28262-8702 |
Second Address | Charlotte, NC 28208-5455 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2019 |
Last Update Date | 08/10/2020 |