1265641179 NPI number — DONNA MOSELEY DEWBERRY RPH

Table of content: DONNA MOSELEY DEWBERRY RPH (NPI 1265641179)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265641179 NPI number — DONNA MOSELEY DEWBERRY RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEWBERRY
Provider First Name:
DONNA
Provider Middle Name:
MOSELEY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPH
Provider Gender Code:
F

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:
1265641179
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5403 NC 96 HWY N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SELMA
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27576
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-965-4659
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
JOHNSTON MEMORIAL HOSPITAL
Provider Second Line Business Practice Location Address:
509 N BRIGHTLEAF BLVD.
Provider Business Practice Location Address City Name:
SMITHFIELD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27577
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-934-8171
Provider Business Practice Location Address Fax Number:
919-934-2274
Provider Enumeration Date:
05/21/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  07477 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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