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General NPI Number Information
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NPI Number | 1851713390
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Entity Type | Organization
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Legal Business Name | BACK TO BASICS HOME MEDICAL VISITS
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Dates
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Enumeration Date | 01/18/2014
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Last Update Date | 06/17/2014
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Provider Practice Location Address
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Address Line | 6600 FRIEDEN CHURCH RD
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City | GIBSONVILLE
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State | NC
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Zip | 27249-9718
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Country | US
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Telephone | 336-446-1141
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Fax | 336-446-0346
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Provider Business Mailing Address
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Address Line | 6600 FRIEDEN CHURCH RD
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City | GIBSONVILLE
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State | NC
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Zip | 27249-9718
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Country | US
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Telephone | 336-446-1141
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Fax | 336-446-0346
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Authorized Official
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Title or Position | OWNER
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Name | JULIE ROSE BARR
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Credential | NP
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Telephone | 336-446-1141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 5005320
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License Number State | NC
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