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General NPI Number Information
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NPI Number | 1184381659
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Entity Type | Individual
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Provider Name | LATIFAH QUANAH JETER FNP-C
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Gender | Female
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Dates
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Enumeration Date | 11/19/2021
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 200 MEDICAL PARK DR STE 550
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City | CONCORD
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State | NC
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Zip | 28025-0947
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Country | US
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Telephone | 704-403-1036
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Fax |
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Provider Business Mailing Address
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Address Line | 3069 LIGHT RIDGE CT SW
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City | CONCORD
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State | NC
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Zip | 28027-8989
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Country | US
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Telephone | 704-930-3145
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5015942
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License Number State | NC
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