Basic Information
| Provider Information | |||||||||
| NPI: | 1689042038 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HACKER | ||||||||
| FirstName: | CAROLINE | ||||||||
| MiddleName: | TEDDER | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MSN, FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 E WENDOVER AVE STE 400 | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274011207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368323150 | ||||||||
| FaxNumber: | 3368323151 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 E WENDOVER AVE STE 400 | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274011207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368323150 | ||||||||
| FaxNumber: | 3368323151 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2015 | ||||||||
| LastUpdateDate: | 08/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 5007935 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.