Basic Information
| Provider Information | |||||||||
| NPI: | 1932117660 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VARNAM FAMILY WELLNESS CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 712 VILLAGE RD | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | SHALLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284703448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107542273 | ||||||||
| FaxNumber: | 9107542254 | ||||||||
| Practice Location | |||||||||
| Address1: | 712 VILLAGE RD | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | SHALLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284703448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107542273 | ||||||||
| FaxNumber: | 9107542254 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2006 | ||||||||
| LastUpdateDate: | 04/01/2008 | ||||||||
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| AuthorizedOfficialLastName: | VARNAM | ||||||||
| AuthorizedOfficialFirstName: | DEBORAH | ||||||||
| AuthorizedOfficialMiddleName: | COGGINS | ||||||||
| AuthorizedOfficialTitleorPosition: | FAMILY NURSE PRACTITIONER/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9107542273 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | MSN RN FNP-C | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 201308 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 018EM | 01 | NC | BCBS OF NC | OTHER | 7003823 | 01 | NC | CAROLINA ACCESS | OTHER | 7003823 | 05 | NC | MEDICAID |