Individual
MR. JONATHAN DANIEL HANCOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1074 SOUTHERN AVE, FAYETTEVILLE, NC 28306-1766
(910) 491-4530
(910) 491-6093
Mailing address
PO BOX 727, STEDMAN, NC 28391-0727
(910) 491-4530
(910) 491-6093
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
5004563
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5004563
NC LISCENSE
NC
Enumeration date
08/18/2009
Last updated
03/21/2017
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