Healthcare Provider Details

I. General information

NPI: 1609888551
Provider Name (Legal Business Name): WANDA CURRIN HANCOCK P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 BETHESDA DR
GREENVILLE NC
27834-7217
US

IV. Provider business mailing address

275 BETHESDA DR
GREENVILLE NC
27834-7217
US

V. Phone/Fax

Practice location:
  • Phone: 252-752-5077
  • Fax: 252-752-3488
Mailing address:
  • Phone: 252-752-5077
  • Fax: 252-752-3488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: