Basic Information
| Provider Information | |||||||||
| NPI: | 1356588073 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BATOULI | ||||||||
| FirstName: | PHUONG | ||||||||
| MiddleName: | H. | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HO | ||||||||
| OtherFirstName: | PHUONG | ||||||||
| OtherMiddleName: | QUOC | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PA | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 12341 STRICKLAND RD | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276131273 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198658000 | ||||||||
| FaxNumber: | 9198658020 | ||||||||
| Practice Location | |||||||||
| Address1: | 12341 STRICKLAND RD | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276131273 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198658000 | ||||||||
| FaxNumber: | 9198658020 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2009 | ||||||||
| LastUpdateDate: | 02/23/2017 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 0010-05476 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.