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General NPI Number Information
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NPI Number | 1356876890
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Entity Type | Organization
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Legal Business Name | MECKLENBURG COUNTY
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Dates
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Enumeration Date | 04/21/2017
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Last Update Date | 04/21/2017
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Provider Practice Location Address
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Address Line | 249 BILLINGSLEY RD
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City | CHARLOTTE
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State | NC
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Zip | 28211-1003
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Country | US
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Telephone | 980-314-9073
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Fax |
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Provider Business Mailing Address
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Address Line | 7023 PASSERES CT
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City | CHARLOTTE
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State | NC
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Zip | 28215-8002
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN EXTENDER
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Name | LISVEL ALEXANDRA MATOS
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Credential | WHNP
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Telephone | 980-314-9073
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP0905X
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Taxonomy Name | State or Local Public Health Clinic/Center
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License Number |
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License Number State |
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