Organization
MECKLENBURG COUNTY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISVEL ALEXANDRA MATOS WHNP (PHYSICIAN EXTENDER)
(980) 314-9073
Entity
Organization
Contact information
Practice address
249 BILLINGSLEY RD, CHARLOTTE, NC 28211-1003
(980) 314-9073
Mailing address
7023 PASSERES CT, CHARLOTTE, NC 28215-8002
Taxonomy
Speciality
Code
Description
License number
State
261QP0905X
State or Local Public Health Clinic/Center
Primary
—
—
Other
Enumeration date
04/21/2017
Last updated
04/21/2017
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