Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 900179 | NC |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 900179 | NC |
NPI | 1154377372 |
---|---|
Provider Name | Terri Lee Koson |
First Address | Charlotte, NC 28289-6206 |
Second Address | New Bern, NC 28562-5253 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 17/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S73277 | (02) | NC |