Provider Demographics
NPI:1154716736
Name:MEAN, EMMA
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:MEAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 601888
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1888
Mailing Address - Country:US
Mailing Address - Phone:704-283-2000
Mailing Address - Fax:704-225-0885
Practice Address - Street 1:1653 CAMPUS PARK DR
Practice Address - Street 2:SUITE A
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-4005
Practice Address - Country:US
Practice Address - Phone:704-283-2000
Practice Address - Fax:704-225-0885
Is Sole Proprietor?:No
Enumeration Date:2015-04-01
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC275386363LP0200X, 363LP0200X
NC5007586363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP3239Medicaid
NC1154716736Medicaid
SCNP3239Medicaid