Individual
VANESSA RENEE CHURCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
207 MEDICAL ST, PILOT MOUNTAIN, NC 27041-8656
(336) 368-5011
(336) 368-1424
Mailing address
PO BOX 751803, CHARLOTTE, NC 28275-1803
(336) 368-5011
(336) 368-1424
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
5015284
NC
363LG0600X
Gerontology Nurse Practitioner
Primary
5015284
NC
Other
Enumeration date
11/05/2021
Last updated
01/29/2025
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