Healthcare Provider Details

I. General information

NPI: 1164827416
Provider Name (Legal Business Name): JENNA ALDRIDGE NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2014
Last Update Date: 04/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2280 HEMBY LN ECU PHYSICIANS NEUROLOGY
GREENVILLE NC
27834-3773
US

IV. Provider business mailing address

PO BOX 751069 ECU PHYSICIANS
CHARLOTTE NC
28275-1069
US

V. Phone/Fax

Practice location:
  • Phone: 252-744-9400
  • Fax: 252-744-9401
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5007285
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number5007285
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number5007285
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: