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Individual
PAULINE DEANNIA FAIRCLOTH
Active
Individual
PAULINE DEANNIA FAIRCLOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
164680
NC
363L00000X
Nurse Practitioner
5004899
NC
363LA2200X
Adult Health Nurse Practitioner
Primary
164680
NC
363LA2200X
Adult Health Nurse Practitioner
Primary
5004899
NC
Other
Enumeration date
10/05/2010
Last updated
04/08/2026
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