Healthcare Provider Details

I. General information

NPI: 1922075910
Provider Name (Legal Business Name): DEBORAH COGGINS VARNAM FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 VILLAGE RD SUITE 106
SHALLOTTE NC
28470
US

IV. Provider business mailing address

712 VILLAGE RD SUITE 106
SHALLOTTE NC
28470
US

V. Phone/Fax

Practice location:
  • Phone: 910-754-2273
  • Fax: 910-754-2254
Mailing address:
  • Phone: 910-754-2273
  • Fax: 910-754-2254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201308
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: