Provider Demographics
NPI:1699530089
Name:NEGRON RIVERA, JANELLE MARIE
Entity type:Individual
Prefix:MS
First Name:JANELLE
Middle Name:MARIE
Last Name:NEGRON RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:336-660-5290
Mailing Address - Fax:336-660-5299
Practice Address - Street 1:7779 NC HIGHWAY 68 N STE 2A
Practice Address - Street 2:
Practice Address - City:STOKESDALE
Practice Address - State:NC
Practice Address - Zip Code:27357-9496
Practice Address - Country:US
Practice Address - Phone:336-660-5290
Practice Address - Fax:336-660-5299
Is Sole Proprietor?:No
Enumeration Date:2024-02-15
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC262349163WE0003X
NC5020942363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WE0003XNursing Service ProvidersRegistered NurseEmergency