Provider Demographics
NPI:1306033816
Name:PODBIELSKI, THERESA (CPNP)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:PODBIELSKI
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2706 MEDICAL OFFICE PLACE
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-9460
Mailing Address - Country:US
Mailing Address - Phone:919-734-4736
Mailing Address - Fax:919-580-1017
Practice Address - Street 1:2706 MEDICAL OFFICE PLACE
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-9460
Practice Address - Country:US
Practice Address - Phone:919-734-4736
Practice Address - Fax:919-580-1017
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20071549363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics