Provider Demographics
NPI:1942065800
Name:ROUNTREE, ANTOINE L
Entity type:Individual
Prefix:MR
First Name:ANTOINE
Middle Name:L
Last Name:ROUNTREE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4921 PROFESSIONAL CT STE 201E
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-4913
Mailing Address - Country:US
Mailing Address - Phone:252-258-6367
Mailing Address - Fax:
Practice Address - Street 1:4921 PROFESSIONAL CT STE 201E
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4913
Practice Address - Country:US
Practice Address - Phone:252-258-6367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC260291376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide