Healthcare Provider Details

I. General information

NPI: 1801889738
Provider Name (Legal Business Name): JUDY R. RAFSON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 10/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 NC HWY 306 SOUTH OCCUPATIONAL HEALTH CLINICT, POTASHCORP-AURORA
AURORA NC
27806
US

IV. Provider business mailing address

628 E. 12TH STREET
WASHINGTON NC
27889
US

V. Phone/Fax

Practice location:
  • Phone: 252-322-8248
  • Fax: 252-322-8030
Mailing address:
  • Phone: 252-745-3191
  • Fax: 252-745-7385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number77113
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: