Basic Information
Provider Information
NPI: 1336758655
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GRASSO
FirstName: STEPHANIE
MiddleName: MORGAN
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 101 MANNING DR
Address2:  
City: CHAPEL HILL
State: NC
PostalCode: 275144220
CountryCode: US
TelephoneNumber: 7033034416
FaxNumber:  
Practice Location
Address1: 101 MANNING DR
Address2:  
City: CHAPEL HILL
State: NC
PostalCode: 275144220
CountryCode: US
TelephoneNumber: 9849741000
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/23/2020
LastUpdateDate: 03/31/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/31/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X5013347NCY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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