| NPI | 1255998944 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN DANIEL HANCOCK Owner/Provider 910-491-4530 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Enumeration Date | 2019-05-29 |
| Last Update Date | 2019-05-31 |