Basic Information
Provider Information | |||||||||
NPI: | 1144529371 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
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OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 208 LAUREL CREST WAY | ||||||||
Address2: |   | ||||||||
City: | SUMMERVILLE | ||||||||
State: | SC | ||||||||
PostalCode: | 294832389 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: |   | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 260 MACNIDER BUILDING | ||||||||
Address2: | CAMPUS BOX 7220 | ||||||||
City: | CHAPEL HILL | ||||||||
State: | NC | ||||||||
PostalCode: | 275990001 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9199661505 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/28/2011 | ||||||||
LastUpdateDate: | 03/28/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | CROWELL | ||||||||
AuthorizedOfficialFirstName: | BRESNEY | ||||||||
AuthorizedOfficialMiddleName: | ALYSSA | ||||||||
AuthorizedOfficialTitleorPosition: | CLINICAL INSTRUCTOR | ||||||||
AuthorizedOfficialTelephone: | 8437547390 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC2000X |   |   | Y |   | Hospitals | General Acute Care Hospital | Children |
No ID Information.