Healthcare Provider Details

I. General information

NPI: 1619383957
Provider Name (Legal Business Name): ANNE OUMAROU FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2014
Last Update Date: 09/09/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 GERARD ST
DURHAM NC
27701-3037
US

IV. Provider business mailing address

1712 BIVINS ST
DURHAM NC
27707-1502
US

V. Phone/Fax

Practice location:
  • Phone: 919-903-6161
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number270424
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5014473
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: