Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 106380 | NC |
NPI | 1205041084 |
---|---|
Provider Name | Ms. Stephannie Cooper Senegal |
First Address | Cary, NC 27513-3035 |
Second Address | Raleigh, NC 27610-1834 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2007 |
Last Update Date | 10/07/2013 |