Basic Information
| Provider Information | |||||||||
| NPI: | 1215387279 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STRADER | ||||||||
| FirstName: | BRITTANY | ||||||||
| MiddleName: | MANNING | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1126 N CHURCH ST | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274011000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3369380800 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 618 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | REIDSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273205020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3369380800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2016 | ||||||||
| LastUpdateDate: | 08/25/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 0010-06495 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.