Provider Demographics
NPI:1902229297
Name:REPMAN, DANITA RENEE (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:DANITA
Middle Name:RENEE
Last Name:REPMAN
Suffix:
Gender:F
Credentials:NP-C
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 602120
Mailing Address - Street 2:100 MEDICAL PARK DR,STE 110
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2120
Mailing Address - Country:US
Mailing Address - Phone:704-403-1370
Mailing Address - Fax:704-403-1389
Practice Address - Street 1:100 MEDICAL PARK DR
Practice Address - Street 2:STE 110
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2966
Practice Address - Country:US
Practice Address - Phone:704-434-6560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-23
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18670363LF0000X
NC5007122363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP2876Medicaid
NC1902229297Medicaid
NC1902229297Medicaid