Individual
MATEE JACKSON DWANAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10206 LEGOLAS LN, CHARLOTTE, NC 28269-7037
(732) 208-6596
Mailing address
10206 LEGOLAS LN, CHARLOTTE, NC 28269-7037
(732) 208-6596
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
310139
NC
Other
Enumeration date
01/09/2023
Last updated
01/09/2023
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