Doctor Name: | MRS. TESS SEBASTIAN JOHN |
NPI Number: | 1205171642 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | 142414 |
Business Practice Address: | 350 Pine State St Lillington, NC - 275469428 |
Business Phone Number: | 9108939700 |
Business Fax Number: | 9108939747 |
Mailing Address: | 350 Pine State St, LILLINGTON |
State: | NC |
Postal Code: | 275469428 |
Phone Number: | 9108939700 |
Fax Number: | 9108939747 |
NPI Enumeration Date: | 12/11/2012 |
NPI Last Update Date: | 12/11/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 142414 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |