Healthcare Provider Details

I. General information

NPI: 1053668848
Provider Name (Legal Business Name): AMY WOZNICKI CP, CFO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2012
Last Update Date: 11/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4702 CREEKSTONE DR
DURHAM NC
27703-8410
US

IV. Provider business mailing address

4702 CREEKSTONE DR
DURHAM NC
27703-8410
US

V. Phone/Fax

Practice location:
  • Phone: 919-797-1230
  • Fax: 919-797-1240
Mailing address:
  • Phone: 919-797-1230
  • Fax: 919-797-1240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberCPO03473
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberCPO03473
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: