Individual
MS. TAWANNA LATRICE HAIRSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
Mailing address
PO BOX 602658, CHARLOTTE, NC 28260-2658
(336) 716-2255
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
900449
NC
Other
Enumeration date
04/12/2006
Last updated
11/02/2012
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