Provider Demographics
NPI:1447622386
Name:NORTH DURHAM WOMEN'S HEALTH
Entity type:Organization
Organization Name:NORTH DURHAM WOMEN'S HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE DIRECTOR/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-908-6449
Mailing Address - Street 1:400 CRUTCHFIELD ST
Mailing Address - Street 2:STE. B
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2771
Mailing Address - Country:US
Mailing Address - Phone:919-908-6449
Mailing Address - Fax:919-908-8355
Practice Address - Street 1:400 CRUTCHFIELD ST
Practice Address - Street 2:STE. B
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2771
Practice Address - Country:US
Practice Address - Phone:919-908-6449
Practice Address - Fax:919-908-8355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-29
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC110748261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center