Individual
JANE SMITH SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
6030 W HIGHWAY 74, STE A, INDIAN TRAIL, NC 28079-3468
(704) 246-2777
Mailing address
PO BOX 19305, CHARLOTTE, NC 28219-9305
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5004952
NC
363LF0000X
Family Nurse Practitioner
5004952
NC
Other
Enumeration date
10/29/2010
Last updated
03/05/2025
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