Healthcare Provider Details

I. General information

NPI: 1376713578
Provider Name (Legal Business Name): DAWN RENEE AGUERO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2008
Last Update Date: 03/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3943 STERLING POINTE DR APT RRR 3
WINTERVILLE NC
28590-5833
US

IV. Provider business mailing address

PSC 827 BOX 284 FPO AE 09617
NAPLES ITALY
09617
IT

V. Phone/Fax

Practice location:
  • Phone: 252-355-3020
  • Fax:
Mailing address:
  • Phone: 340-096-1802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001195311
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: