Provider Demographics
NPI:1194854778
Name:TEWOLDE, CATHERINE JANELL (CNP)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:JANELL
Last Name:TEWOLDE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8521 TONAWANDA DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-1802
Mailing Address - Country:US
Mailing Address - Phone:704-668-1555
Mailing Address - Fax:
Practice Address - Street 1:332 SAM NEWELL RD
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-6566
Practice Address - Country:US
Practice Address - Phone:704-302-8583
Practice Address - Fax:704-302-8548
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5003379363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7004477Medicaid
SCNP1296Medicaid
NC2593016AMedicare PIN
SCNP1296Medicaid