Healthcare Provider Details

I. General information

NPI: 1558225946
Provider Name (Legal Business Name): FATIMA MGHAZLI WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11134 TREVI VILLAGE BLVD APT 106 APT 106
CHARLOTTE NC
28262-0344
US

IV. Provider business mailing address

11134 TREVI VILLAGE BLVD APT 106
CHARLOTTE NC
28262-0344
US

V. Phone/Fax

Practice location:
  • Phone: 919-348-8716
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number104484481
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: