Provider Information for 1871083139
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JENNIFER PAULINE BEADELL
Sex: Female
NPI: 1871083139
Last Updated: 2018-11-28
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1871083139 | ||||||||||||
| Enumeration Date | 2018-05-12 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 284 EXECUTIVE PARK DR STE 100 CONCORD, NC 28025-1833 United States Phone: 704-939-1100 | Fax:704-939-1173 | ||||||||||||
| Primary Practice Address | 227 N MAIN ST TROY, NC 27371 United States Phone: 910-572-3681 | Fax:910-572-5579 | ||||||||||||
| Secondary Practice Address(es) | 1219 ROCKINGHAM RD | ||||||||||||
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