Provider Demographics
NPI:1750572848
Name:NTUEN, TINA CELESTINE (NP)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:CELESTINE
Last Name:NTUEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 E CORNWALLIS DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-5103
Mailing Address - Country:US
Mailing Address - Phone:336-274-0179
Mailing Address - Fax:
Practice Address - Street 1:309 E CORNWALLIS DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-5103
Practice Address - Country:US
Practice Address - Phone:336-274-0179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCF05220120363LF0000X
NCHC2883374U00000X
NC5016959363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408427Medicaid
NC7100552Medicaid
NC6601257Medicaid