Doctor Name: | MR. JONATHAN LABAYO DESAMERO |
NPI Number: | 1003804972 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | FNP-C |
License Number: | 119624 |
Business Practice Address: | 4530 Park Rd Suite 200 Charlotte, NC - 282093716 |
Business Phone Number: | 7045276322 |
Business Fax Number: | |
Mailing Address: | 6232 Arden Forest Circle, CLEMMONS |
State: | NC |
Postal Code: | 270129402 |
Phone Number: | 3367782858 |
Fax Number: | |
NPI Enumeration Date: | 10/13/2005 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 119624 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |