Healthcare Provider Details

I. General information

NPI: 1336986892
Provider Name (Legal Business Name): ANNA HAWLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2024
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 ADAIR DR
GOLDSBORO NC
27530-4516
US

IV. Provider business mailing address

PO BOX 187
FAISON NC
28341-0187
US

V. Phone/Fax

Practice location:
  • Phone: 919-648-8932
  • Fax: 910-356-2311
Mailing address:
  • Phone: 910-267-2042
  • Fax: 855-996-9090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5020473
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: