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General NPI Number Information
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NPI Number | 1881377299
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Entity Type | Organization
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Legal Business Name | SELECTWELL
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Dates
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Enumeration Date | 08/11/2023
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Last Update Date | 08/11/2023
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Provider Practice Location Address
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Address Line | 1175 REVOLUTION MILL DR STE 10
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City | GREENSBORO
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State | NC
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Zip | 27405-5080
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Country | US
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Telephone | 336-510-1120
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Fax | 336-235-3044
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Provider Business Mailing Address
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Address Line | PO BOX 13029
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City | GREENSBORO
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State | NC
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Zip | 27415-3029
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Country | US
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Telephone | 336-510-1120
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Fax | 336-235-3044
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | KIMBERLY AGAMEDI
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Credential | NP
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Telephone | 336-510-1120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1800X
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Taxonomy Name | Corporate Health Clinic/Center
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License Number |
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License Number State |
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