Organization
EXTENSION TRAINING OF NC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CHRISTINA LANETTE STEVENSON FNP, ANP, RN-BC (OWNER)
(919) 592-3608
Entity
Organization
Contact information
Practice address
700 MORROW AVE, PINEVILLE, NC 28134-6528
(919) 592-3608
(919) 835-9613
Mailing address
1120 LOMBAR ST, RALEIGH, NC 27610-6499
(704) 806-2156
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
254418
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5007400
NURSE PRACTITIONER
NC
Enumeration date
09/18/2017
Last updated
09/18/2017
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