Healthcare Provider Details

I. General information

NPI: 1427604883
Provider Name (Legal Business Name): JEANETTE RENEA TORAIN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2019
Last Update Date: 08/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 KIMEL PARK DR STE 100
WINSTON SALEM NC
27103-6983
US

IV. Provider business mailing address

145 KIMEL PARK DR STE 100
WINSTON SALEM NC
27103-6983
US

V. Phone/Fax

Practice location:
  • Phone: 336-768-6347
  • Fax: 336-760-9393
Mailing address:
  • Phone: 336-768-6347
  • Fax: 336-760-9393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberTORA-QRNNK7
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5012122
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: