Doctor Name: | MRS. ERICA TERESA FENNELL |
NPI Number: | 1376863423 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | FCL-082-017 |
Business Practice Address: | 1436 Bland School Rd Harrells, NC - 284447609 |
Business Phone Number: | 9105324805 |
Business Fax Number: | 9105324805 |
Mailing Address: | 1436 Bland School Rd, HARRELLS |
State: | NC |
Postal Code: | 284447609 |
Phone Number: | 9105324805 |
Fax Number: | 9105324805 |
NPI Enumeration Date: | 06/10/2010 |
NPI Last Update Date: | 06/10/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | FCL-082-017 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |