Healthcare Provider Details

I. General information

NPI: 1982425336
Provider Name (Legal Business Name): NICOLE NEUGEBAUER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2024
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2607 W ARROWOOD RD
CHARLOTTE NC
28273-6134
US

IV. Provider business mailing address

2607 W ARROWOOD RD
CHARLOTTE NC
28273-6134
US

V. Phone/Fax

Practice location:
  • Phone: 704-588-0232
  • Fax: 704-588-0445
Mailing address:
  • Phone: 704-588-0232
  • Fax: 704-588-0445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number5025658
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number257637
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: