=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932086675
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAROLYNE SENDOLO RN, FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2025
-----------------------------------------------------
Last Update Date | 08/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10936 GOLD PAN RD
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28215-8603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-839-1977
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12316 SHERBORNE ST
-----------------------------------------------------
City | BRISTOW
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20136-2002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-863-8145
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 2011008790
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------