Individual
MACKENSIE GRANT DE LA ROCA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
181 DANIEL RD, FOREST CITY, NC 28043-7151
(828) 286-9036
Mailing address
PO BOX 19305, CHARLOTTE, NC 28219-9305
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
5013589
NC
363LF0000X
Family Nurse Practitioner
Primary
5013589
NC
Other
Enumeration date
11/02/2020
Last updated
07/15/2024
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