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Individual

DALLAS BANNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
3000 NEW BERN AVE, RALEIGH, NC 27610-1231
(919) 350-8114
Mailing address
5115 PARK RD APT 302, CHARLOTTE, NC 28209-3820

Taxonomy

Speciality
Code
Description
License number
State
163WU0100X
Urology Registered Nurse
259156
NC
208800000X
Urology Physician
5012314
NC
363L00000X
Nurse Practitioner
Primary
5012314
NC

Other

Enumeration date
08/01/2019
Last updated
10/07/2024
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