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General NPI Number Information
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NPI Number | 1730943663
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Entity Type | Individual
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Provider Name | AUSTIN FANN FNP-C
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Gender | Male
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Dates
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Enumeration Date | 02/12/2024
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Last Update Date | 02/12/2024
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Provider Practice Location Address
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Address Line | 58 OLD ROBERTS RD # 102
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City | BENSON
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State | NC
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Zip | 27504-8047
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Country | US
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Telephone | 919-934-2600
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Fax |
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Provider Business Mailing Address
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Address Line | 1145 MCPHAIL RD
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City | ROSEBORO
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State | NC
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Zip | 28382-7066
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Country | US
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Telephone | 910-214-6792
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5019605
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License Number State | NC
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