Healthcare Provider Details

I. General information

NPI: 1023873056
Provider Name (Legal Business Name): BRENDETTA HUFFMAN-ROWE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2024
Last Update Date: 02/19/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10211 ALM ST STE 210
RALEIGH NC
27617-8221
US

IV. Provider business mailing address

110 LARKSPUR CIR
DURHAM NC
27713-2502
US

V. Phone/Fax

Practice location:
  • Phone: 919-620-5333
  • Fax: 919-307-0323
Mailing address:
  • Phone: 919-338-6423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number5019659
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: