Healthcare Provider Details

I. General information

NPI: 1346253978
Provider Name (Legal Business Name): MY LINH THI WALDROP ANP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 11/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9614 CAMDEN TOWN DR NW
CONCORD NC
28027-3332
US

IV. Provider business mailing address

8820 UNIVERSITY EAST DR
CHARLOTTE NC
28213-4218
US

V. Phone/Fax

Practice location:
  • Phone: 704-408-6285
  • Fax:
Mailing address:
  • Phone: 704-408-6285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0050-01105
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: