Healthcare Provider Details

I. General information

NPI: 1639462104
Provider Name (Legal Business Name): JEANNA ROSELLA AURIEMMA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2011
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEDICAL CENTER BLVD WAKE FOREST BAPTIST HOSPITAL
WINSTON SALEM NC
27157-0001
US

IV. Provider business mailing address

MEDICAL CENTER BLVD WAKE FOREST BAPTIST HOSPITAL
WINSTON SALEM NC
27157-0001
US

V. Phone/Fax

Practice location:
  • Phone: 336-716-5222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2014-00723
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier390200000X
Identifier TypeOTHER
Identifier StateNC
Identifier Issuer390200000X

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: