Provider Demographics
NPI:1598228488
Name:DEMEULENAERE, KATHERINE ROSA (FNP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ROSA
Last Name:DEMEULENAERE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:ROSA
Other - Last Name:NEWBERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:781 AVENT FERRY RD STE 102
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-7776
Mailing Address - Country:US
Mailing Address - Phone:919-567-6120
Mailing Address - Fax:
Practice Address - Street 1:781 AVENT FERRY RD STE 102
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-7776
Practice Address - Country:US
Practice Address - Phone:919-567-6120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-09
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041438860163W00000X
IL209019277363LF0000X
NC5015254363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041438860OtherREGISTER NURSE