Provider Demographics
NPI:1386814291
Name:MEREDITH, ONDREA S (RN, CFM)
Entity Type:Individual
Prefix:
First Name:ONDREA
Middle Name:S
Last Name:MEREDITH
Suffix:
Gender:F
Credentials:RN, CFM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24574
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27114-4574
Mailing Address - Country:US
Mailing Address - Phone:336-760-4333
Mailing Address - Fax:336-760-1433
Practice Address - Street 1:1409 PLAZA WEST DR
Practice Address - Street 2:STE D
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1418
Practice Address - Country:US
Practice Address - Phone:336-760-4333
Practice Address - Fax:336-760-1433
Is Sole Proprietor?:No
Enumeration Date:2008-03-06
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy Fitter
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1232850001Medicare NSC