Healthcare Provider Details

I. General information

NPI: 1215302120
Provider Name (Legal Business Name): THAIH RCOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2015
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 N BENBOW RD
GREENSBORO NC
27401-3202
US

IV. Provider business mailing address

112 N BENBOW RD
GREENSBORO NC
27401-3202
US

V. Phone/Fax

Practice location:
  • Phone: 336-334-7880
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF07260447
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: