Healthcare Provider Details

I. General information

NPI: 1306920285
Provider Name (Legal Business Name): BETH THOMASON WRENN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2609 N DUKE ST SUITE 204
DURHAM NC
27704-3048
US

IV. Provider business mailing address

2609 N DUKE ST STE 204
DURHAM NC
27704-5936
US

V. Phone/Fax

Practice location:
  • Phone: 919-220-5435
  • Fax: 919-220-5435
Mailing address:
  • Phone: 919-220-5435
  • Fax: 919-220-5572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number201577
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: