Healthcare Provider Details

I. General information

NPI: 1407903743
Provider Name (Legal Business Name): AMBER RENN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 05/17/2025
Certification Date: 05/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 RAWLS ROAD
ANGIER NC
27501
US

IV. Provider business mailing address

PO BOX 1833
ANGIER NC
27501-1833
US

V. Phone/Fax

Practice location:
  • Phone: 919-331-2477
  • Fax: 919-331-2481
Mailing address:
  • Phone: 919-331-2477
  • Fax: 919-331-2481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number103531
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: