Provider Demographics
NPI:1750494647
Name:FENNELL, DANA C (MSN RN CS)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:C
Last Name:FENNELL
Suffix:
Gender:F
Credentials:MSN RN CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 BROWNING PLACE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6555
Mailing Address - Country:US
Mailing Address - Phone:919-787-7125
Mailing Address - Fax:919-781-9952
Practice Address - Street 1:3900 BROWNING PLACE
Practice Address - Street 2:SUITE 201
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6555
Practice Address - Country:US
Practice Address - Phone:919-787-7125
Practice Address - Fax:919-781-9952
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC61137163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00235326OtherRAILROAD MEDICARE
NCP00235326OtherRAILROAD MEDICARE