Healthcare Provider Details

I. General information

NPI: 1902229297
Provider Name (Legal Business Name): DANITA RENEE REPMAN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2014
Last Update Date: 11/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MEDICAL PARK DR STE 110
CONCORD NC
28025-2966
US

IV. Provider business mailing address

PO BOX 602120 100 MEDICAL PARK DR,STE 110
CHARLOTTE NC
28260-2120
US

V. Phone/Fax

Practice location:
  • Phone: 704-434-6560
  • Fax:
Mailing address:
  • Phone: 704-403-1370
  • Fax: 704-403-1389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18670
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5007122
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: