Community Practitioner Program
Dashboard
date-266
2021-08-24
Professional
Physician Asstistant
PracticeName
Durham Practice
MonthYearStartedPracticingCurrentSite
2021-08-31
PracticeCity
Durham
Practice
28900
OfficePhone
555-555-5555
HomeAddress
7440 Bright Leaf Rd.
HomeState
NC
HomeCounty
new hanover
NCMedicalBoardLicenseNumber
12345555
checkbox-589
No
checkbox-924
Yes
textarea-514
PercentageofPractice
2
practicebusinessmanager
Nancy Been
EmailAddress
nancy@gmail.com
practitionerssalary
99,009
Signature
Bob Manny
file-233
a3b6e4bfd9b5c17e7d5cc1543635bc9e
Sequence Number
your-name
Bob Manny
Type
Primary Care
MonthYearStartedPracticing
2021-08-02
PracticeAddress
7440 Bright Leaf Rd.
PracticeState
NC
PracticeCounty
durham
HomePhone
555-555-5555
HomeCity
Wilmington
HomeZip
28411
your-email
durham@gmail.com
checkbox-900
No
PracticesManagementStructureandPrincipalOwners
Practice management structure: Regional Director, Regional Operation Manager, and Medical Director
Principal owner: Vidant Health Systems
Listallprovidersandtheirprofessionalstatus
Dr. Toghjfte, MD
Dr. Mefghjding, MD
Amanda Cagfhjfgn, AGNP-
checkbox-864
Yes,Yes,Yes,Yes,Yes,Yes,No,No,No,No,No,No,No,No,No,No
NumberofPatients
345
ContactNumber
555-555-5555
languagesspoken
French
Loanamount
40,000
date-533
2021-08-24
Entry ID
2021/08/24 at 1:36 pm