Provider Demographics
NPI:1649935792
Name:FAUST, DENISE ALXANDRIA (NURSING ASSTISTANT)
Entity type:Individual
Prefix:MS
First Name:DENISE
Middle Name:ALXANDRIA
Last Name:FAUST
Suffix:
Gender:F
Credentials:NURSING ASSTISTANT
Other - Prefix:MISS
Other - First Name:DENISE
Other - Middle Name:ALXANDRIA
Other - Last Name:FAUST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSING ASSISTANT
Mailing Address - Street 1:223 HAILEY STONE CT
Mailing Address - Street 2:
Mailing Address - City:WAGENER
Mailing Address - State:SC
Mailing Address - Zip Code:29164-8402
Mailing Address - Country:US
Mailing Address - Phone:919-897-3904
Mailing Address - Fax:
Practice Address - Street 1:223 HAILEY STONE CT
Practice Address - Street 2:
Practice Address - City:WAGENER
Practice Address - State:SC
Practice Address - Zip Code:29164-8402
Practice Address - Country:US
Practice Address - Phone:919-897-3904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health