Healthcare Provider Details

I. General information

NPI: 1710262696
Provider Name (Legal Business Name): DR. KATIE ELLEN VENNERI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2011
Last Update Date: 10/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5311 N ROXBORO RD
DURHAM NC
27712-2227
US

IV. Provider business mailing address

100 VILLAGE CIRCLE WAY APT 521
DURHAM NC
27713-6133
US

V. Phone/Fax

Practice location:
  • Phone: 919-471-4409
  • Fax:
Mailing address:
  • Phone: 724-322-1802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number22061
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: