Healthcare Provider Details

I. General information

NPI: 1588087100
Provider Name (Legal Business Name): JANELLA WILSON CNA/MEDICINE TECH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2014
Last Update Date: 02/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 KENDALL DR
DURHAM NC
27703-5235
US

IV. Provider business mailing address

1202 KENDALL DR
DURHAM NC
27703-5235
US

V. Phone/Fax

Practice location:
  • Phone: 919-884-5141
  • Fax:
Mailing address:
  • Phone: 919-884-5141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number373504
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number373504
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number373504
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number373504
License Number StateNC
# 5
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number373504
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: