Healthcare Provider Details

I. General information

NPI: 1083096630
Provider Name (Legal Business Name): REBECCA KAY CICALE NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2015
Last Update Date: 06/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 LLOYD ST
CARRBORO NC
27510-1823
US

IV. Provider business mailing address

301 LLOYD ST
CARRBORO NC
27510-1823
US

V. Phone/Fax

Practice location:
  • Phone: 919-933-8494
  • Fax: 919-933-9201
Mailing address:
  • Phone: 919-933-8494
  • Fax: 919-933-9201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number900453
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: