Healthcare Provider Details

I. General information

NPI: 1285417261
Provider Name (Legal Business Name): JESSICA HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2023
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 VINE ST STE 230
WINSTON SALEM NC
27101-4158
US

IV. Provider business mailing address

525 VINE ST STE 230
WINSTON SALEM NC
27101-4158
US

V. Phone/Fax

Practice location:
  • Phone: 336-716-1411
  • Fax:
Mailing address:
  • Phone: 336-716-1411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number8018
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: