Provider Demographics
NPI:1891984514
Name:FENATUORA, CAL SAMUEL CHUDE (BA)
Entity Type:Individual
Prefix:MR
First Name:CAL
Middle Name:SAMUEL CHUDE
Last Name:FENATUORA
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:7 SMOKY RIVER CT
Mailing Address - Street 2:7 SMOKEYRIVER COURT
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-4809
Mailing Address - Country:US
Mailing Address - Phone:919-408-6114
Mailing Address - Fax:919-408-6114
Practice Address - Street 1:7 SMOKY RIVER CT
Practice Address - Street 2:#BOX 15001
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-4809
Practice Address - Country:US
Practice Address - Phone:919-408-6114
Practice Address - Fax:919-408-6114
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC5666760251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health