Basic Information
Provider Information | |||||||||
NPI: | 1558865444 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | NORTH CAROLINA NEPHROLOGY PA | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
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Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
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OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
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OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3031 NEW BERN AVE STE 306 | ||||||||
Address2: |   | ||||||||
City: | RALEIGH | ||||||||
State: | NC | ||||||||
PostalCode: | 276102989 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9192313966 | ||||||||
FaxNumber: | 9192313912 | ||||||||
Practice Location | |||||||||
Address1: | 1006 N ARENDELL AVE | ||||||||
Address2: |   | ||||||||
City: | ZEBULON | ||||||||
State: | NC | ||||||||
PostalCode: | 275972352 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9192313966 | ||||||||
FaxNumber: | 9192313912 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/23/2018 | ||||||||
LastUpdateDate: | 03/23/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | CAPPS | ||||||||
AuthorizedOfficialFirstName: | JENNIFER | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
AuthorizedOfficialTelephone: | 9194598409 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
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NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.