Healthcare Provider Details

I. General information

NPI: 1912042920
Provider Name (Legal Business Name): CAPE CARTERET FAMILY MEDICINE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 10/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1057 CEDAR POINT BLVD UNIT D
CEDAR POINT NC
28584-8020
US

IV. Provider business mailing address

1057 CEDAR POINT BLVD UNIT D
CEDAR POINT NC
28584-8020
US

V. Phone/Fax

Practice location:
  • Phone: 252-764-2121
  • Fax: 252-764-2135
Mailing address:
  • Phone: 252-764-2121
  • Fax: 252-764-2135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201471
License Number StateNC

VIII. Authorized Official

Name: JOANNE D LILES
Title or Position: OWNER
Credential: NP
Phone: 252-764-2121