Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 5001921 | NC |
NPI | 1013122092 |
---|---|
Provider Name | Mrs. Joy Lianne Justice |
First Address | Charlotte, NC 28260-4042 |
Second Address | Winston Salem, NC 27103-5614 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2007 |
Last Update Date | 18/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7006048 | (05) | NC |