Individual
MRS. NICHOLE LOWERY CLONTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGNP
Contact information
Practice address
2616 E 5TH ST, CHARLOTTE, NC 28204-4343
(704) 333-5165
Mailing address
8401 MEDICAL PLAZA DR STE 365, CHARLOTTE, NC 28262-8700
(704) 944-0975
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5015868
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5015868
STATE LICENSING
NC
Enumeration date
03/02/2022
Last updated
03/02/2022
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