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General NPI Number Information
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NPI Number | 1851761407
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Entity Type | Organization
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Legal Business Name | QUALITY CARE MEDICAL CLINIC
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Dates
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Enumeration Date | 09/25/2015
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Last Update Date | 09/25/2015
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Provider Practice Location Address
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Address Line | 5124 MONROE RD
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City | CHARLOTTE
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State | NC
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Zip | 28205-7826
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Country | US
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Telephone | 980-777-3651
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Fax | 704-983-9242
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Provider Business Mailing Address
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Address Line | 5124 MONROE RD
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City | CHARLOTTE
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State | NC
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Zip | 28205-7826
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Country | US
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Telephone | 980-777-3651
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Fax | 704-983-9242
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | PACHARO SALLY NDUPU
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Credential | NP-C
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Telephone | 980-777-3651
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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 | 190528
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License Number State | NC
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