Healthcare Provider Details

I. General information

NPI: 1174178453
Provider Name (Legal Business Name): SHOUKANG ZHU NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 08/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 VEAZEY DR
BUTNER NC
27509-1668
US

IV. Provider business mailing address

2608 CAMELLIA DR APT G
DURHAM NC
27705-6723
US

V. Phone/Fax

Practice location:
  • Phone: 919-764-2000
  • Fax:
Mailing address:
  • Phone: 786-218-3943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5012087
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: