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NPI Code Detail

MEDICARE: IRENE MARIA CHILDRESS NP

MEDICARE: IRENE MARIA CHILDRESS NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse PractitionerRN185501GA
2363L00000XNurse Practitioner5006781NC

General Provider Information

NPI Number : 1326300617
Entity Type Code : Individual
Provider Name (Legal Business Name) : IRENE MARIA CHILDRESS NP
Provider Business Mailing Address
First Line : MEDICAL CENTER BLVD
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27157-0001
Country : US
Telephone Number : 336-716-2255
Fax Number : 336-716-3202
Provider Business Practice Location Address
First Line : 1510 HEBRON RD
Second Line :
City : HENDERSONVILLE
State : NC
Zip : 28739-4794
Country : US
Telephone Number : 828-693-8461
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2012
Last Update Date : 09/02/2024

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