Provider Demographics
NPI:1306990197
Name:PRONURSE MEDICAL STAFFING, INC
Entity type:Organization
Organization Name:PRONURSE MEDICAL STAFFING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:THOMASINA
Authorized Official - Middle Name:SMITH
Authorized Official - Last Name:LANEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-347-4767
Mailing Address - Street 1:1014 S TRYON ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-4225
Mailing Address - Country:US
Mailing Address - Phone:704-347-4767
Mailing Address - Fax:704-347-4770
Practice Address - Street 1:1014 S TRYON ST
Practice Address - Street 2:SUITE 106
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-4225
Practice Address - Country:US
Practice Address - Phone:704-347-4767
Practice Address - Fax:704-347-4770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC1855163W00000X, 163WI0500X, 164W00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
Not Answered163WI0500XNursing Service ProvidersRegistered NurseInfusion TherapyGroup - Multi-Specialty
Not Answered164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
Not Answered376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6600719Medicaid