Provider Demographics
NPI:1033321005
Name:ANNA GOVE STUDENT HEALTH SERVICES
Entity Type:Organization
Organization Name:ANNA GOVE STUDENT HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:MRS
Authorized Official - First Name:AGNES
Authorized Official - Middle Name:IHECHINYERE
Authorized Official - Last Name:NWOKO
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:336-227-8413
Mailing Address - Street 1:1413 ELM ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27217-1241
Mailing Address - Country:US
Mailing Address - Phone:336-227-8413
Mailing Address - Fax:
Practice Address - Street 1:107 GRAY DR.
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27402
Practice Address - Country:US
Practice Address - Phone:336-334-3185
Practice Address - Fax:336-334-5343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33362261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC=========OtherTAX ID NUMBER