Healthcare Provider Details

I. General information

NPI: 1336556034
Provider Name (Legal Business Name): AMY HUACANI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2014
Last Update Date: 07/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2670 DURHAM CHAPEL HILL BLVD
DURHAM NC
27707-2829
US

IV. Provider business mailing address

2670 DURHAM CHAPEL HILL BLVD
DURHAM NC
27707-2829
US

V. Phone/Fax

Practice location:
  • Phone: 919-251-9001
  • Fax: 919-251-9008
Mailing address:
  • Phone: 919-251-9001
  • Fax: 919-251-9008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberP009091
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: