Community Practitioner Program
Dashboard
date-266
2021-09-23
Professional
Physician Asstistant
PracticeName
Yetty Practice
MonthYearStartedPracticingCurrentSite
2021-09-20
PracticeCity
Wilmington
Practice
28411
OfficePhone
9106125782
HomeAddress
7440 Bright Leaf Rd.
HomeState
NC
HomeCounty
NC
NCMedicalBoardLicenseNumber
134513451345
checkbox-589
No
checkbox-924
No
textarea-514
asdfasdfasdf
PercentageofPractice
3
practicebusinessmanager
Yolonda James
EmailAddress
yj@gmail.com
practitionerssalary
90,000
Signature
Jo Yetty
file-233
Sequence Number
your-name
Joseph Yetty
Type
Primary Care
MonthYearStartedPracticing
2021-09-24
PracticeAddress
7313 Denly Court
PracticeState
NC
PracticeCounty
NC
HomePhone
9106125782
HomeCity
Wilmington
HomeZip
28411
your-email
sipes.joseph@gmail.com
checkbox-900
No
PracticesManagementStructureandPrincipalOwners
asdfasdf
Listallprovidersandtheirprofessionalstatus
asdfasdf
checkbox-864
Yes,No,No,Yes,Yes,Yes,Yes,Yes,Yes,Yes,Yes,No,No,No,No,No
NumberofPatients
333
ContactNumber
9106125782
languagesspoken
asdfsdfsfd
Loanamount
90,000
date-533
2021-09-25
Entry ID
2021/09/06 at 3:41 pm