| NPI | 1962934059 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE BRATHWAITE Nurse Practitioner 704-919-3564 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 1548520935) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 1548675648) |
| Enumeration Date | 2017-03-29 |
| Last Update Date | 2017-03-29 |