Provider Demographics
NPI:1114334794
Name:FAWCETT-HARDY, JUNE ANNE
Entity Type:Individual
Prefix:
First Name:JUNE
Middle Name:ANNE
Last Name:FAWCETT-HARDY
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:JUNE
Other - Middle Name:ANNE
Other - Last Name:FAWCETT-HARDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 601843
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1843
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1122 RANDOLPH ST STE 110
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-5730
Practice Address - Country:US
Practice Address - Phone:336-481-0739
Practice Address - Fax:336-481-0738
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5006997363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily