Community Practitioner Program
Dashboard
date-266
2021-08-24
Professional
Physician Asstistant
PracticeName
Practice Name
MonthYearStartedPracticingCurrentSite
PracticeCity
Cary
Practice
28455
OfficePhone
555-555-5556
HomeAddress
7440 Bright Leaf Rd.
HomeState
nc
HomeCounty
Cary
NCMedicalBoardLicenseNumber
23453-34534
checkbox-589
No
checkbox-924
No
textarea-514
PercentageofPractice
1
practicebusinessmanager
Terry
EmailAddress
terry@gmail.com
practitionerssalary
60,000
Signature
Dan Steel
file-233
Sequence Number
your-name
Dan Steel
Type
Primary Care
MonthYearStartedPracticing
PracticeAddress
HealthPlex-Cary
PracticeState
nc
PracticeCounty
Cary
HomePhone
555-555-5555
HomeCity
Cary
HomeZip
28455
your-email
cary@gmail.com
checkbox-900
No
PracticesManagementStructureandPrincipalOwners
Listallprovidersandtheirprofessionalstatus
checkbox-864
No,No,Yes,Yes,No,Yes,Yes,No,No,No,No,No,No,No,No,No
NumberofPatients
1234
ContactNumber
555-555-5555
languagesspoken
n/a
Loanamount
100,000
date-533
2021-08-24
Entry ID
2021/08/24 at 2:12 pm