Individual
BEENA JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4505 FAIR MEADOWS LN STE 101, RALEIGH, NC 27607-6449
(919) 787-4000
Mailing address
23 FINISH LINE RD, BAHAMA, NC 27503-9657
(919) 479-6785
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5011196
NC
Other
Enumeration date
11/12/2018
Last updated
11/12/2018
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