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General NPI Number Information
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NPI Number | 1689073447
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Entity Type | Organization
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Legal Business Name | XUBIAN WELLNESS & ACNE CLINIC, P.C.
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Dates
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Enumeration Date | 08/18/2014
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Last Update Date | 08/18/2014
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Provider Practice Location Address
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Address Line | 201 S MCPHERSON CHURCH RD STE 228
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-4995
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Country | US
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Telephone | 910-429-2263
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Fax |
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Provider Business Mailing Address
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Address Line | 2811 EAGLE CREST LN
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City | FAYETTEVILLE
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State | NC
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Zip | 28306-8093
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Country | US
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Telephone | 910-574-7882
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Fax |
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | MRS. STACY WASHINGTON
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Credential | RN
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Telephone | 910-429-2263
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 222305
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License Number State | NC
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