Individual
MRS. DEANNA KREIDEL BATH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, PA-C
Contact information
Practice address
125 QUEENS RD STE 540, CHARLOTTE, NC 28204-3215
(980) 302-6560
(980) 302-6565
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
103847
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0778PA
—
SC
05
—
8101344
—
NC
Enumeration date
09/14/2007
Last updated
08/11/2021
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