Healthcare Provider Details

I. General information

NPI: 1750494647
Provider Name (Legal Business Name): DANA C FENNELL MSN RN CS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 03/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 BROWNING PLACE SUITE 201
RALEIGH NC
27609-6555
US

IV. Provider business mailing address

3900 BROWNING PLACE SUITE 201
RALEIGH NC
27609-6555
US

V. Phone/Fax

Practice location:
  • Phone: 919-787-7125
  • Fax: 919-781-9952
Mailing address:
  • Phone: 919-787-7125
  • Fax: 919-781-9952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number61137
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: