Healthcare Provider Details

I. General information

NPI: 1144607243
Provider Name (Legal Business Name): 1ST CHOICE MEDICAL STAFFING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2015
Last Update Date: 04/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2311 WEST CONE BLVD. SUITE # 227
GREENSBORO NC
27408
US

IV. Provider business mailing address

2311 WEST CONE BLVD. SUITE # 227
GREENSBORO NC
27408
US

V. Phone/Fax

Practice location:
  • Phone: 336-500-8734
  • Fax: 877-485-6270
Mailing address:
  • Phone: 336-500-8734
  • Fax: 877-485-6270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number162296
License Number StateNC

VIII. Authorized Official

Name: CLAUDETTE VENDETTA JOHNSON
Title or Position: AGENCY DIRECTOR
Credential: RN, BSN, MNA
Phone: 336-500-8734