Healthcare Provider Details

I. General information

NPI: 1174155683
Provider Name (Legal Business Name): MICHELLE LEE STROUP FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2020
Last Update Date: 11/04/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9764 HOLLY SPRINGS RD
APEX NC
27539
US

IV. Provider business mailing address

9764 HOLLY SPRINGS RD
APEX NC
27539-7620
US

V. Phone/Fax

Practice location:
  • Phone: 910-486-6818
  • Fax:
Mailing address:
  • Phone: 919-557-6667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number256650
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5012858
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: