Provider Demographics
NPI:1609262146
Name:PASSMORE, TEWANA
Entity Type:Individual
Prefix:
First Name:TEWANA
Middle Name:
Last Name:PASSMORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 BUXTON WAY
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-9435
Mailing Address - Country:US
Mailing Address - Phone:404-809-1207
Mailing Address - Fax:
Practice Address - Street 1:1407 E FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2886
Practice Address - Country:US
Practice Address - Phone:919-913-0996
Practice Address - Fax:919-918-4981
Is Sole Proprietor?:No
Enumeration Date:2015-04-10
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN210698363LF0000X
SC20304363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily