| NPI | 1770872228 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONNA LYNN SQUIRES Insurance Billing Manager 910-506-4679 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NC 900344) |
| Enumeration Date | 2011-04-06 |
| Last Update Date | 2015-12-23 |