Provider Demographics
NPI:1295235620
Name:MCDERMOTT, JOANNE MARILYN (NP-C)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:MARILYN
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ATRIUM HEALTH LIVEWELL CARE-PINEVILLE
Mailing Address - Street 2:10620 PARK ROAD SUITE 202
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-0106
Mailing Address - Country:US
Mailing Address - Phone:508-308-5731
Mailing Address - Fax:
Practice Address - Street 1:ATRIUM HEALTH LIVEWELL CARE-PINEVILLE
Practice Address - Street 2:10620 PARK ROAD SUITE 202
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-0106
Practice Address - Country:US
Practice Address - Phone:704-667-7920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-12
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9279648363L00000X
NC5019737363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner