Healthcare Provider Details

I. General information

NPI: 1487479655
Provider Name (Legal Business Name): ENVI COLE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2024
Last Update Date: 11/21/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4949 ALBERMARLE ROAD
CHARLOTTE NC
28205
US

IV. Provider business mailing address

4949 ALBERMARLE ROAD 4949 ALBERMARLE ROAD
CHARLOTTE NC
28205
US

V. Phone/Fax

Practice location:
  • Phone: 704-532-4262
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number234179
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: