MEDICARE: ALEXIS PASSINGHAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	5006184	NC

General Provider Information

NPI Number	:	1568808251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS PASSINGHAM

Provider Business Mailing Address
First Line	:	206 N DYSON ST
Second Line	:
City	:	HOLLY RIDGE
State	:	NC
Zip	:	28445-8502
Country	:	US
Telephone Number	:	910-329-7591
Fax Number	:

Provider Business Practice Location Address
First Line	:	206 N DYSON ST
Second Line	:
City	:	HOLLY RIDGE
State	:	NC
Zip	:	28445-8502
Country	:	US
Telephone Number	:	910-329-7591
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2013
Last Update Date	:	10/15/2013

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Directions to “ ALEXIS PASSINGHAM ” Practice Location

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