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NPI Code Detail

MEDICARE: JANE S FAWCETT NP

MEDICARE: JANE S FAWCETT 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
1363LF0000XFamily Nurse Practitioner200360NC

General Provider Information

NPI Number : 1417083148
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANE S FAWCETT NP
Provider Business Mailing Address
First Line : 4420 SOLEMN POINT LN
Second Line :
City : CHARLOTTE
State : NC
Zip : 28216-8505
Country : US
Telephone Number : 704-576-7901
Fax Number :
Provider Business Practice Location Address
First Line : 2845 BEATTIES FORD RD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28216-3711
Country : US
Telephone Number : 704-336-6500
Fax Number : 704-336-4806
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/26/2007
Last Update Date : 07/27/2011

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