1053575233 NPI number — FAYETTEVILLE STATE UNIVERSITY/DEPT OF NURSING

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053575233 NPI number — FAYETTEVILLE STATE UNIVERSITY/DEPT OF NURSING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAYETTEVILLE STATE UNIVERSITY/DEPT OF NURSING
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053575233
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 MURCHISON ROAD
Provider Second Line Business Mailing Address:
THE SPAULDING BUILDING
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28301-4252
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-672-2602
Provider Business Mailing Address Fax Number:
910-672-1366

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 MURCHISON ROAD
Provider Second Line Business Practice Location Address:
THE SPAULDING BUILDING
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28301-4252
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-672-2602
Provider Business Practice Location Address Fax Number:
910-672-1366
Provider Enumeration Date:
07/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
GORDON
Authorized Official First Name:
VINETTE
Authorized Official Middle Name:
EILY
Authorized Official Title or Position:
DIRECTOR STUDENT HEALTH CENTER
Authorized Official Telephone Number:
910-672-2602

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  46437 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QH0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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