Individual
CHARLEY TYRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
2627 WINDING CV, GRIMESLAND, NC 27837-8612
(252) 217-8288
Mailing address
PO BOX 333, MANNS HARBOR, NC 27953-0333
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
5006569
NC
Other
Enumeration date
10/31/2013
Last updated
03/09/2022
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