Healthcare Provider Details

I. General information

NPI: 1760647127
Provider Name (Legal Business Name): ELIZABETH BROOKS SCISM FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2008
Last Update Date: 03/07/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 N NC-16 HWY BUS, STE 104
DENVER NC
28037-3008
US

IV. Provider business mailing address

PO BOX 470408
CHARLOTTE NC
28247-0408
US

V. Phone/Fax

Practice location:
  • Phone: 704-487-4677
  • Fax: 704-481-8050
Mailing address:
  • Phone: 704-887-6402
  • Fax: 704-887-6450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5004032
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: