| NPI | 1720395783 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISSY GAYLE FOHR Nurse Practitioner 336-414-1164 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NC 5004119) |
| Enumeration Date | 2010-09-10 |
| Last Update Date | 2024-03-18 |