Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 930025 | NC |
NPI | 1194077271 |
---|---|
Provider Name | Theresa Robertson Mcdonald |
First Address | Fletcher, NC 28732-1869 |
Second Address | Hendersonville, NC 28792-5272 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2012 |
Last Update Date | 07/12/2016 |