Healthcare Provider Details

I. General information

NPI: 1912373341
Provider Name (Legal Business Name): KA-RON DAWN HAUMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2015
Last Update Date: 08/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 TREETOP DR
FAYETTEVILLE NC
28311-0606
US

IV. Provider business mailing address

4150 NASH RD
FAYETTEVILLE NC
28306-7329
US

V. Phone/Fax

Practice location:
  • Phone: 910-488-9008
  • Fax:
Mailing address:
  • Phone: 910-689-5523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5655
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: