Healthcare Provider Details

I. General information

NPI: 1609900067
Provider Name (Legal Business Name): CATHY WHITE CRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1147 HALLBERRY DR
FAYETTEVILLE NC
28314-1827
US

IV. Provider business mailing address

1147 HALLBERRY DR
FAYETTEVILLE NC
28314-1827
US

V. Phone/Fax

Practice location:
  • Phone: 910-867-2340
  • Fax: 910-867-2340
Mailing address:
  • Phone: 910-867-2340
  • Fax: 910-867-2340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number2180
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: