Healthcare Provider Details

I. General information

NPI: 1891773008
Provider Name (Legal Business Name): EILEEN MARIE QUILTY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 05/28/2020
Certification Date: 05/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2645 MERIDIAN PKWY STE 323
DURHAM NC
27713-4232
US

IV. Provider business mailing address

10320 FELD FARM LN STE 300
CHARLOTTE NC
28210-8484
US

V. Phone/Fax

Practice location:
  • Phone: 984-227-8902
  • Fax:
Mailing address:
  • Phone: 704-541-0925
  • Fax: 704-541-0924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0006-00036
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number600036
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: