Individual
JORDAN NICHOLAS DE LAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
815 SPRINGFIELD COMMONS DR, RALEIGH, NC 27609-8529
(919) 235-1400
Mailing address
PO BOX 602195, CHARLOTTE, NC 28260-2195
(919) 350-0351
(919) 350-7687
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0010-11134
NC
363AM0700X
Medical Physician Assistant
Primary
0010-11134
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1174103626
—
NC
Enumeration date
04/09/2021
Last updated
07/10/2024
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