Individual
EARLENE BOHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
725 HIGHLAND AVE, WINSTON SALEM, NC 27101-4206
(336) 768-7200
(336) 768-7200
Mailing address
1100 S STRATFORD RD, WINSTON SALEM, NC 27103-3217
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
122684
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
122684
RN
NC
Enumeration date
12/22/2006
Last updated
06/03/2010
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