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General NPI Number Information
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NPI Number | 1083056287
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Entity Type | Organization
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Legal Business Name | ECSU STUDENT HEALTH SERVICES
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Dates
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Enumeration Date | 07/29/2013
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Last Update Date | 07/29/2013
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Provider Practice Location Address
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Address Line | 1704 WEEKSVILLE RD
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City | ELIZABETH CITY
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State | NC
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Zip | 27909-7977
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Country | US
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Telephone | 252-335-3267
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Fax | 252-335-3269
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Provider Business Mailing Address
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Address Line | 1704 WEEKSVILLE RD
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City | ELIZABETH CITY
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State | NC
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Zip | 27909-7977
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Country | US
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Telephone | 252-335-3267
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Fax | 252-335-3269
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Authorized Official
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Title or Position | DIRECTOR
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Name | REGINA MCCOY-DAVIS
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Credential | RN, MSN
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Telephone | 252-335-3267
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1000X
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Taxonomy Name | Student Health Clinic/Center
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License Number |
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License Number State |
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