Provider Demographics
NPI:1194133108
Name:AXNER, BRITTANY N (PAC)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:N
Last Name:AXNER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4527 JESSUP GROVE RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-9407
Mailing Address - Country:US
Mailing Address - Phone:336-632-9272
Mailing Address - Fax:866-554-1610
Practice Address - Street 1:4527 JESSUP GROVE RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-9407
Practice Address - Country:US
Practice Address - Phone:336-632-9272
Practice Address - Fax:866-554-1610
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-05180363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1194133108OtherBCBS-NC
NC1194133108Medicaid
NC1194133108Medicaid