Provider Demographics
NPI:1679274765
Name:PALMETTO PRIMARY HEALTHCARE PLLC
Entity type:Organization
Organization Name:PALMETTO PRIMARY HEALTHCARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WHRITENOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-316-1468
Mailing Address - Street 1:4850 FAYETTEVILLE RD STE G
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2374
Mailing Address - Country:US
Mailing Address - Phone:910-316-1468
Mailing Address - Fax:
Practice Address - Street 1:4850 FAYETTEVILLE RD STE G
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2374
Practice Address - Country:US
Practice Address - Phone:910-316-1468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty