Individual
JENNIFER LOUISE PERCIVAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5145 SELLERS RD, SHALLOTTE, NC 28470-3405
(910) 754-4441
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(910) 754-4441
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
275979
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1053702076
—
NC
Enumeration date
02/12/2015
Last updated
08/05/2024
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