Healthcare Provider Details

I. General information

NPI: 1912757824
Provider Name (Legal Business Name): TANETRIA D HUFFIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 03/25/2024
Certification Date: 03/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 N 4TH ST
WILMINGTON NC
28401-3412
US

IV. Provider business mailing address

440 JASMINE WAY
BURGAW NC
28425-4320
US

V. Phone/Fax

Practice location:
  • Phone: 272-336-4231
  • Fax:
Mailing address:
  • Phone: 272-336-4231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: