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NPI Code Detail

MEDICARE: MARY BOYD WHITESIDES NEAL NP

MEDICARE:   MARY BOYD WHITESIDES NEAL  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 Practitioner5006721NC

General Provider Information

NPI Number : 1861816134
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY BOYD WHITESIDES NEAL NP
Provider Business Mailing Address
First Line : PO BOX 19305
Second Line :
City : CHARLOTTE
State : NC
Zip : 28219-9305
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7030 PINEVILLE MATTHEWS RD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28226-8298
Country : US
Telephone Number : 704-667-4150
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/07/2014
Last Update Date : 07/15/2024

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