Healthcare Provider Details

I. General information

NPI: 1437895232
Provider Name (Legal Business Name): ANNMARIE FUSCO BANKSTON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2022
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 YADKIN ST STE 301
ALBEMARLE NC
28001-3456
US

IV. Provider business mailing address

105 YADKIN ST STE 301
ALBEMARLE NC
28001-3456
US

V. Phone/Fax

Practice location:
  • Phone: 980-323-5360
  • Fax:
Mailing address:
  • Phone: 980-323-5360
  • Fax: 980-323-5361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5016248
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: