Healthcare Provider Details

I. General information

NPI: 1487209318
Provider Name (Legal Business Name): STILL WATERS FAMILY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2019
Last Update Date: 08/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 E MAIN ST
BURNSVILLE NC
28714-3101
US

IV. Provider business mailing address

53 WINDY OAKS RDG
BURNSVILLE NC
28714-7252
US

V. Phone/Fax

Practice location:
  • Phone: 828-260-9082
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: STEPHYNIA LIMONGELLO
Title or Position: OWNER
Credential: FNP
Phone: 828-290-9082