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NPI Code Detail

MEDICARE: MARK RANDOLPH JULARBAL NP

MEDICARE: MARK RANDOLPH JULARBAL NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner5011595NC

General Provider Information

NPI Number : 1720547771
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK RANDOLPH JULARBAL NP
Provider Business Mailing Address
First Line : 13944 PINYON PINE LN
Second Line :
City : CHARLOTTE
State : NC
Zip : 28215-7151
Country : US
Telephone Number : 704-502-8590
Fax Number :
Provider Business Practice Location Address
First Line : 131 MILLER ST
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27103-2508
Country : US
Telephone Number : 336-716-8094
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/19/2019
Last Update Date : 06/23/2020

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