Healthcare Provider Details

I. General information

NPI: 1336428036
Provider Name (Legal Business Name): WANETTA HARRIETTE HARRINGTON RN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2011
Last Update Date: 08/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 ROXIE AVE
FAYETTEVILLE NC
28304-2137
US

IV. Provider business mailing address

105 ROXIE AVE
FAYETTEVILLE NC
28304-2137
US

V. Phone/Fax

Practice location:
  • Phone: 910-609-1880
  • Fax: 910-609-1836
Mailing address:
  • Phone: 910-609-1880
  • Fax: 910-609-1836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number06511
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: