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NPI Code Detail

MEDICARE: WENDELL CLAVONN JOHN RN, MSN, FNP-C

MEDICARE: WENDELL CLAVONN JOHN RN, MSN, FNP-C
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 Practitioner201749NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1201749OTHERNCNC NURSE PRACTITIONER #
2170923OTHERNCNC NURSING LICENSE #

General Provider Information

NPI Number : 1942288790
Entity Type Code : Individual
Provider Name (Legal Business Name) : WENDELL CLAVONN JOHN RN, MSN, FNP-C
Provider Business Mailing Address
First Line : PO BOX 96860
Second Line :
City : CHARLOTTE
State : NC
Zip : 28296-6860
Country : US
Telephone Number : 919-761-5678
Fax Number :
Provider Business Practice Location Address
First Line : 620 DR CALVIN JONES HWY STE 212
Second Line :
City : WAKE FOREST
State : NC
Zip : 27587-3108
Country : US
Telephone Number : 919-761-5678
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2006
Last Update Date : 02/04/2026

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