Healthcare Provider Details

I. General information

NPI: 1912365099
Provider Name (Legal Business Name): STEPHYNIA LIMONGELLO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2016
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 SEVEN MILE RIDGE RD
BURNSVILLE NC
28714-8509
US

IV. Provider business mailing address

53 WINDY OAKS RDG
BURNSVILLE NC
28714-7252
US

V. Phone/Fax

Practice location:
  • Phone: 828-675-4116
  • Fax: 828-675-9312
Mailing address:
  • Phone: 828-260-9082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5008334
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: