Provider Demographics
NPI:1356588073
Name:BATOULI, PHUONG H (PA-C)
Entity type:Individual
Prefix:MRS
First Name:PHUONG
Middle Name:H
Last Name:BATOULI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:PHUONG
Other - Middle Name:QUOC
Other - Last Name:HO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:12341 STRICKLAND RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-1273
Mailing Address - Country:US
Mailing Address - Phone:919-865-8000
Mailing Address - Fax:919-865-8020
Practice Address - Street 1:12341 STRICKLAND RD
Practice Address - Street 2:SUITE 102
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-1273
Practice Address - Country:US
Practice Address - Phone:919-865-8000
Practice Address - Fax:919-865-8020
Is Sole Proprietor?:No
Enumeration Date:2009-01-16
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-05476363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant