Basic Information
| Provider Information | |||||||||
| NPI: | 1588804827 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | THANAWALA | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 930 MARTIN LUTHER KING JR BLVD | ||||||||
| Address2: | STE 202 | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275142656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199333301 | ||||||||
| FaxNumber: | 9199333375 | ||||||||
| Practice Location | |||||||||
| Address1: | 4551 NEW BERN AVE | ||||||||
| Address2: | STE 160 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195561008 | ||||||||
| FaxNumber: | 9195566099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2009 | ||||||||
| LastUpdateDate: | 12/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | 1804 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.