Individual
MAXIM A EFREMOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ACNP
Contact information
Practice address
MEDICAL CENTER BLVD, WAKE FOREST UNIVERSITY HEALTH SCIENCES, WINSTON SALEM, NC 27157-0001
(336) 716-2011
Mailing address
MEDICAL CENTER BLVD, WAKE FOREST UNIVERSITY HEALTH SCIENCES, WINSTON SALEM, NC 27157-0001
(336) 716-2011
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
5006044
NC
363LA2100X
Acute Care Nurse Practitioner
CNP01073
NM
363LA2100X
Acute Care Nurse Practitioner
R45111
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
99609754
—
NM
01
—
NPI & TIN
BCBS OF NM
NM
Enumeration date
04/11/2006
Last updated
03/04/2014
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