Healthcare Provider Details

I. General information

NPI: 1114044682
Provider Name (Legal Business Name): CAROLINA SKIN & VEIN CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 02/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7110 WRIGHTSVILLE AVE SUITE B 9
WILMINGTON NC
28403-7219
US

IV. Provider business mailing address

7110 WRIGHSTVILLE AVENUE SUITE B 9
WILMINGTON NC
28403
US

V. Phone/Fax

Practice location:
  • Phone: 910-509-4116
  • Fax: 910-509-7566
Mailing address:
  • Phone: 910-509-4116
  • Fax: 910-509-7566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number9600064
License Number StateNC

VIII. Authorized Official

Name: CINDY L. NIXON
Title or Position: INSURANCE SPECIALIST
Credential:
Phone: 910-616-1815