Healthcare Provider Details

I. General information

NPI: 1831982305
Provider Name (Legal Business Name): KARTHIKA PANNEERSELVAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 WAKE FOREST RD
RALEIGH NC
27609-7317
US

IV. Provider business mailing address

612 LONG LAKE DR
FUQUAY VARINA NC
27526-3761
US

V. Phone/Fax

Practice location:
  • Phone: 919-954-3000
  • Fax:
Mailing address:
  • Phone: 402-305-5452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number361650
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: