Individual
REGINALD FENNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN, MSN, PHD, FNP-BC
Contact information
Practice address
1801 FAYETTEVILLE ST, DURHAM, NC 27707-3129
(919) 530-6317
(919) 530-7969
Mailing address
PO BOX 19491, DURHAM, NC 27707-0020
(919) 530-6317
(919) 530-7969
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5012410
NC
Other
Enumeration date
10/11/2019
Last updated
11/01/2019
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