Healthcare Provider Details

I. General information

NPI: 1598326456
Provider Name (Legal Business Name): JUANTIA APPLEWHITE NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2019
Last Update Date: 12/07/2020
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1804 FOREST HILLS RD W
WILSON NC
27893-3413
US

IV. Provider business mailing address

1204 CAMDEN AVE
DURHAM NC
27701-1427
US

V. Phone/Fax

Practice location:
  • Phone: 252-237-8161
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5012000
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number240812
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: