Healthcare Provider Details

I. General information

NPI: 1083795389
Provider Name (Legal Business Name): MARY WAYNETTE HARRISON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JAMES A TAYLOR CAMPUS HEALTH CB# 7470 JAMES A TAYLOR BLDG.
CHAPEL HILL NC
27514
US

IV. Provider business mailing address

2501 BOOKER CREEK RD
CHAPEL HILL NC
27514-5121
US

V. Phone/Fax

Practice location:
  • Phone: 919-966-6573
  • Fax:
Mailing address:
  • Phone: 919-969-8919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1400X
TaxonomyCollege Health Registered Nurse
License Number086187
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: