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General NPI Number Information
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NPI Number | 1962648279
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Entity Type | Individual
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Provider Name | JENNIFER DENNIS MIRAMONTES FNP
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Gender | Female
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Dates
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Enumeration Date | 12/17/2008
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Last Update Date | 12/17/2008
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Provider Practice Location Address
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Address Line | 2153 VALLEYGATE DR SUITE 102
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-3681
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Country | US
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Telephone | 910-321-7246
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Fax | 910-321-7245
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Provider Business Mailing Address
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Address Line | 7712 CHARRING CROSS LN
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City | FAYETTEVILLE
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State | NC
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Zip | 28314-6301
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Country | US
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Telephone | 910-321-7246
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Fax | 910-321-7245
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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 | 5004180
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License Number State | NC
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