Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC1500X | Nurse Practitioner - Community Health | RN045021NP | GA |
NPI | 1962400606 |
---|---|
Provider Name | Ms. Connis Norwood |
First Address | Cumming, GA 30040-0307 |
Second Address | Cumming, GA 30040-0307 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2005 |
Last Update Date | 23/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RN045021NP | GA NURSE PRACT LICENSE # (01) | GA |