MEDICARE: CAROLE MCDUFFIE VENABLE RNC FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	39673	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2599191C	OTHER	NC	MEDICARE

General Provider Information

NPI Number	:	1396737375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLE MCDUFFIE VENABLE RNC FNP

Provider Business Mailing Address
First Line	:	PO BOX 1446
Second Line	:
City	:	ROCKINGHAM
State	:	NC
Zip	:	28380-1446
Country	:	US
Telephone Number	:	910-895-6650
Fax Number	:	910-895-6682

Provider Business Practice Location Address
First Line	:	125 BILTMORE DR
Second Line	:	SUITE #2
City	:	ROCKINGHAM
State	:	NC
Zip	:	28379-4994
Country	:	US
Telephone Number	:	910-895-6650
Fax Number	:	910-895-6682

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	10/27/2010

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