Provider Demographics
NPI:1730648163
Name:HUFHAM, ANETTE LORELLA
Entity Type:Individual
Prefix:
First Name:ANETTE
Middle Name:LORELLA
Last Name:HUFHAM
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 1:9324 HANOVER SOUTH TRL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-7731
Mailing Address - Country:US
Mailing Address - Phone:980-254-5755
Mailing Address - Fax:
Practice Address - Street 1:2805 HEATHSTEAD PL
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-7160
Practice Address - Country:US
Practice Address - Phone:980-254-5755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-15
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC006255367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered