Provider Demographics
NPI:1053575233
Name:FAYETTEVILLE STATE UNIVERSITY/DEPT OF NURSING
Entity type:Organization
Organization Name:FAYETTEVILLE STATE UNIVERSITY/DEPT OF NURSING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR STUDENT HEALTH CENTER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VINETTE
Authorized Official - Middle Name:EILY
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-672-2602
Mailing Address - Street 1:1200 MURCHISON ROAD
Mailing Address - Street 2:THE SPAULDING BUILDING
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-4252
Mailing Address - Country:US
Mailing Address - Phone:910-672-2602
Mailing Address - Fax:910-672-1366
Practice Address - Street 1:1200 MURCHISON ROAD
Practice Address - Street 2:THE SPAULDING BUILDING
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-4252
Practice Address - Country:US
Practice Address - Phone:910-672-2602
Practice Address - Fax:910-672-1366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-16
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QH0100X
NC46437282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No282N00000XHospitalsGeneral Acute Care Hospital