Provider Demographics
NPI:1770164048
Name:PENDERGRAFT, EMILY PHILLIPS (NBHWC COACH)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:PHILLIPS
Last Name:PENDERGRAFT
Suffix:
Gender:F
Credentials:NBHWC COACH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-3026
Mailing Address - Country:US
Mailing Address - Phone:843-252-1111
Mailing Address - Fax:
Practice Address - Street 1:5915 FARRINGTON RD STE 10
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-9900
Practice Address - Country:US
Practice Address - Phone:843-252-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date: