Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 243623 | NC |
Y | 363L00000X | Nurse Practitioner | 5007782 | NC |
NPI | 1003297342 |
---|---|
Provider Name | Ms. Anisha Jones |
First Address | Monroe, NC 28112-6000 |
Second Address | Matthews, NC 28105-4656 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2015 |
Last Update Date | 28/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003297342 | (05) | NC |
NCP250A | (02) | NC |
NP3348 | (05) | SC |