Healthcare Provider Details

I. General information

NPI: 1679034219
Provider Name (Legal Business Name): SONDRA MICHELLE UPTON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MANNING DR
CHAPEL HILL NC
27514-4220
US

IV. Provider business mailing address

3942 COPPER TRACE DR
HAW RIVER NC
27258-9458
US

V. Phone/Fax

Practice location:
  • Phone: 984-974-4721
  • Fax:
Mailing address:
  • Phone: 919-636-1882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5011641
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: