Individual
EDGARDO JOSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
302 MARY BETH DR, GREENVILLE, NC 27858-8118
(910) 322-4032
Mailing address
302 MARY BETH DR, GREENVILLE, NC 27858-8118
(910) 322-4032
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
5008452
NC
Other
Enumeration date
03/17/2016
Last updated
03/17/2016
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