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General NPI Number Information
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NPI Number | 1598326456
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Entity Type | Individual
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Provider Name | JUANTIA APPLEWHITE NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 06/21/2019
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Last Update Date | 12/07/2020
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Provider Practice Location Address
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Address Line | 1804 FOREST HILLS RD W
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City | WILSON
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State | NC
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Zip | 27893-3413
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Country | US
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Telephone | 252-237-8161
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Fax |
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Provider Business Mailing Address
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Address Line | 1204 CAMDEN AVE
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City | DURHAM
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State | NC
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Zip | 27701-1427
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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 | 5012000
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 163WG0600X
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Taxonomy Name | Gerontology Registered Nurse
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License Number | 240812
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License Number State | NC
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