Provider Demographics
NPI:1306920285
Name:WRENN, BETH THOMASON (NP)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:THOMASON
Last Name:WRENN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2609 N DUKE ST STE 204
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-5936
Mailing Address - Country:US
Mailing Address - Phone:919-220-5435
Mailing Address - Fax:919-220-5572
Practice Address - Street 1:2609 N DUKE ST
Practice Address - Street 2:SUITE 204
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-3048
Practice Address - Country:US
Practice Address - Phone:919-220-5435
Practice Address - Fax:919-220-5435
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201577363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2806008AMedicare PIN
P55201Medicare UPIN
NC2806008BMedicare PIN