Healthcare Provider Details

I. General information

NPI: 1104548411
Provider Name (Legal Business Name): BRIANNE MICHALA BARNETTE REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2022
Last Update Date: 09/13/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 TRENT DR
DURHAM NC
27710-3038
US

IV. Provider business mailing address

7094 WHITBY AVE
CLEMMONS NC
27012-9475
US

V. Phone/Fax

Practice location:
  • Phone: 919-684-4248
  • Fax:
Mailing address:
  • Phone: 336-780-1815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number297660
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: