Healthcare Provider Details

I. General information

NPI: 1528092137
Provider Name (Legal Business Name): PANDA CLINARD ROWLAND RRT,RCP, PSGT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 RAMSEY ST
FAYETTEVILLE NC
28301-3856
US

IV. Provider business mailing address

6588 ROCKFISH RD
RAEFORD NC
28376-6138
US

V. Phone/Fax

Practice location:
  • Phone: 910-488-2120
  • Fax:
Mailing address:
  • Phone: 910-875-8838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279G1100X
TaxonomyGeneral Care Registered Respiratory Therapist
License Number1631
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: