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NPI Code Detail

MEDICARE: LARA JORDAN PETERSON DAVIS MSN, APRN, FNP-C

MEDICARE: LARA JORDAN PETERSON DAVIS MSN, APRN, FNP-C
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
1363L00000XNurse PractitionerF08231056NC

General Provider Information

NPI Number : 1972378099
Entity Type Code : Individual
Provider Name (Legal Business Name) : LARA JORDAN PETERSON DAVIS MSN, APRN, FNP-C
Provider Business Mailing Address
First Line : 1490 WILLIAMSBORO ST
Second Line :
City : OXFORD
State : NC
Zip : 27565-3498
Country : US
Telephone Number : 919-729-5704
Fax Number :
Provider Business Practice Location Address
First Line : 1490 WILLIAMSBORO ST
Second Line :
City : OXFORD
State : NC
Zip : 27565-3498
Country : US
Telephone Number : 919-729-5704
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/20/2023
Last Update Date : 11/28/2023

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