Individual
MISS CHARISSE N FULLWOOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
10901 WORLD TRADE BLVD, RALEIGH, NC 27617-4203
(919) 372-4408
Mailing address
10901 WORLD TRADE BLVD, RALEIGH, NC 27617-4203
(919) 372-4408
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
0000000
NC
Other
Enumeration date
10/29/2021
Last updated
12/06/2021
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