Healthcare Provider Details

I. General information

NPI: 1043238587
Provider Name (Legal Business Name): SUSAN FLOWERS FREDERICK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 05/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 CROSSOVER RD
BEULAVILLE NC
28518-8800
US

IV. Provider business mailing address

1850 W ARLINGTON BLVD
GREENVILLE NC
27834-5704
US

V. Phone/Fax

Practice location:
  • Phone: 910-298-4688
  • Fax: 910-298-4628
Mailing address:
  • Phone: 252-413-6740
  • Fax: 252-752-6600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2006004306
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: