Provider Demographics
NPI:1457650384
Name:FAUCETTE, DEONNA L (PA-C)
Entity Type:Individual
Prefix:
First Name:DEONNA
Middle Name:L
Last Name:FAUCETTE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 US HIGHWAY 220 N
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27358-9207
Mailing Address - Country:US
Mailing Address - Phone:336-643-7738
Mailing Address - Fax:
Practice Address - Street 1:4601 US HIGHWAY 220 N
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:NC
Practice Address - Zip Code:27358-9207
Practice Address - Country:US
Practice Address - Phone:336-643-7738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-17
Last Update Date:2016-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103532363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant