Healthcare Provider Details

I. General information

NPI: 1437701877
Provider Name (Legal Business Name): ANNA BINET WOLVERTON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2019
Last Update Date: 07/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 HOSPICE CIR
RALEIGH NC
27607-6372
US

IV. Provider business mailing address

2604 CLOUD MIST CIR
RALEIGH NC
27614-6631
US

V. Phone/Fax

Practice location:
  • Phone: 919-828-0890
  • Fax:
Mailing address:
  • Phone: 919-818-1744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5011991
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: