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General NPI Number Information
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NPI Number | 1184642415
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Entity Type | Individual
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Provider Name | ELIZABETH RENEE PREVETTE ANP-BC, DACHM
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Gender | Female
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 04/09/2025
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Provider Practice Location Address
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Address Line | 6324 FAIRVIEW RD STE 310
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City | CHARLOTTE
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State | NC
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Zip | 28210-4172
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Country | US
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Telephone | 980-302-8680
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Fax | 980-302-8681
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Provider Business Mailing Address
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Address Line | PO BOX 60447
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City | CHARLOTTE
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State | NC
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Zip | 28260-0447
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | AP2416
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 5021705
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License Number State | NC
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