Healthcare Provider Details

I. General information

NPI: 1093310799
Provider Name (Legal Business Name): TREVOR PACKER FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2020
Last Update Date: 12/01/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2905 CROUSE LN
BURLINGTON NC
27215-8833
US

IV. Provider business mailing address

120 TADWORTH CT
MEBANE NC
27302-8673
US

V. Phone/Fax

Practice location:
  • Phone: 336-538-2494
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5013839
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: