Healthcare Provider Details

I. General information

NPI: 1093305393
Provider Name (Legal Business Name): NATHALY YINNES ESCALANTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2021
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 E CHARLOTTE AVE DEPT 451
MT HOLLY NC
28120-2211
US

IV. Provider business mailing address

451 E CHARLOTTE AVE DEPT 451
MT HOLLY NC
28120-2211
US

V. Phone/Fax

Practice location:
  • Phone: 704-834-2000
  • Fax:
Mailing address:
  • Phone: 704-834-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number314634
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: