Individual
ENNIE AUSTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
186 KIMEL PARK DR, WINSTON SALEM, NC 27103-6946
(336) 277-2000
(336) 277-2050
Mailing address
PO BOX 751803, CHARLOTTE, NC 28275-1803
(336) 277-2000
(336) 277-2050
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5011958
NC
363LF0000X
Family Nurse Practitioner
5011958
NC
Other
Enumeration date
07/26/2019
Last updated
10/26/2020
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