Basic Information
| Provider Information | |||||||||
| NPI: | 1730362104 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCNINCH | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | JORDEN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5821 FAIRVIEW RD STE 106 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282093649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048263550 | ||||||||
| FaxNumber: | 7045384135 | ||||||||
| Practice Location | |||||||||
| Address1: | 5821 FAIRVIEW RD STE 106 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282093649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048263550 | ||||||||
| FaxNumber: | 7045384135 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2007 | ||||||||
| LastUpdateDate: | 02/24/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 201501 | NC | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | 201501 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.