Healthcare Provider Details

I. General information

NPI: 1730648163
Provider Name (Legal Business Name): ANETTE LORELLA HUFHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2019
Last Update Date: 10/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2805 HEATHSTEAD PL
CHARLOTTE NC
28210-7160
US

IV. Provider business mailing address

9324 HANOVER SOUTH TRL
CHARLOTTE NC
28210-7731
US

V. Phone/Fax

Practice location:
  • Phone: 980-254-5755
  • Fax:
Mailing address:
  • Phone: 980-254-5755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number006255
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: