Healthcare Provider Details

I. General information

NPI: 1780798041
Provider Name (Legal Business Name): JANESE AGNEW TRIVETTE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 TATE BLVD SE STE 170
HICKORY NC
28602-4012
US

IV. Provider business mailing address

915 TATE BLVD SE STE 170
HICKORY NC
28602-4012
US

V. Phone/Fax

Practice location:
  • Phone: 828-345-0800
  • Fax: 828-345-0350
Mailing address:
  • Phone: 828-345-0800
  • Fax: 828-345-0350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0050-00714
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0050-00714
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: