Organization
INTEGRATED PRIMARY CARE AND BEHAVIORAL HEALTH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TAWANDA BOSTIC DNP,PMHNP-BC, FNP-BC (OWNER)
(704) 322-4699
Entity
Organization
Contact information
Practice address
6201 FAIRVIEW RD, SUITE 200, CHARLOTTE, NC 28210-3289
(704) 322-4699
(704) 992-9546
Mailing address
6201 FAIRVIEW RD, SUITE 200, CHARLOTTE, NC 28210-3289
(704) 322-4699
(704) 992-9546
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
196483
NC
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
196483
NC
Other
Enumeration date
02/10/2015
Last updated
03/30/2015
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