Individual
DEANNA POULK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
2029 VALLEYGATE DR STE 101, FAYETTEVILLE, NC 28304-3772
(910) 323-2103
(910) 323-2219
Mailing address
2029 VALLEYGATE DR STE 101, FAYETTEVILLE, NC 28304-3772
(910) 323-2103
(910) 323-2219
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
237626
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
237626
NURSES LICENSE
NC
Enumeration date
05/23/2011
Last updated
05/23/2011
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