Healthcare Provider Details

I. General information

NPI: 1174741599
Provider Name (Legal Business Name): RAVEN JAMES CRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CROMWELL DR # B
GREENVILLE NC
27858-5852
US

IV. Provider business mailing address

700 CROMWELL DR # B
GREENVILLE NC
27858-5852
US

V. Phone/Fax

Practice location:
  • Phone: 252-830-2094
  • Fax: 252-355-7358
Mailing address:
  • Phone: 252-830-2094
  • Fax: 252-355-7358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License NumberA4294
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: