Basic Information
| Provider Information | |||||||||
| NPI: | 1538899570 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WASZCZENIUK | ||||||||
| FirstName: | COURTNEY | ||||||||
| MiddleName: | WHITE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 208 BRENTWOOD DR | ||||||||
| Address2: | |||||||||
| City: | ADVANCE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 270069440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3363392269 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3333 SILAS CREEK PKWY | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271033013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367659328 | ||||||||
| FaxNumber: | 3367685762 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2022 | ||||||||
| LastUpdateDate: | 06/13/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 5016349 | NC | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 363L00000X | 5016349 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.