Healthcare Provider Details

I. General information

NPI: 1336078401
Provider Name (Legal Business Name): REINALDO BORGES DE SOUZA RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 TILGHMAN DR
DUNN NC
28334-5510
US

IV. Provider business mailing address

222 W DOVE RIDGE LN
SPRING LAKE NC
28390-9106
US

V. Phone/Fax

Practice location:
  • Phone: 910-827-0602
  • Fax:
Mailing address:
  • Phone: 910-827-0602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number383251
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: