| NPI | 1336599547 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MONICA DIANNE ZELLOUS Practice Manager 336-553-0793 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services (Licence: NC 5004483) |
| 261QH0100X Clinic/Center, Health Services (Licence: NC 5006433) | |
| Enumeration Date | 2016-06-18 |
| Last Update Date | 2024-04-04 |