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General NPI Number Information
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NPI Number | 1295016681
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Entity Type | Organization
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Legal Business Name | PREFERRED HOME AND HOSPICE CARE AND OPT PLLC
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Dates
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Enumeration Date | 08/30/2011
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Last Update Date | 06/06/2013
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Provider Practice Location Address
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Address Line | 401 TATE ST
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City | GREENSBORO
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State | NC
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Zip | 27403-2523
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Country | US
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Telephone | 336-740-0897
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Fax |
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Provider Business Mailing Address
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Address Line | 401 TATE ST
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City | GREENSBORO
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State | NC
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Zip | 27403-2523
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Country | US
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Telephone | 336-684-5330
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. JEAN WILSON
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Credential | C-FNP
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Telephone | 336-740-0897
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 26NJ00418200
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R127999
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License Number State | MD
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