Provider Demographics
NPI:1356855092
Name:HOMETOWN HOUSE CALLS, PLLC
Entity Type:Organization
Organization Name:HOMETOWN HOUSE CALLS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:T
Authorized Official - Last Name:BANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:704-648-1970
Mailing Address - Street 1:6428 W WILKINSON BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012-2858
Mailing Address - Country:US
Mailing Address - Phone:704-616-9691
Mailing Address - Fax:
Practice Address - Street 1:6428 W WILKINSON BLVD STE 210
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:NC
Practice Address - Zip Code:28012-2858
Practice Address - Country:US
Practice Address - Phone:704-616-9691
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-16
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty