Healthcare Provider Details

I. General information

NPI: 1659687457
Provider Name (Legal Business Name): JOANN MARIE ANDERSON CRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2010
Last Update Date: 08/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11345 US HIGHWAY 17 N
VANCEBORO NC
28586-9095
US

IV. Provider business mailing address

11345 US HIGHWAY 17 N
VANCEBORO NC
28586-9095
US

V. Phone/Fax

Practice location:
  • Phone: 252-474-4609
  • Fax: 252-321-9390
Mailing address:
  • Phone: 252-474-4609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number3897
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: