Healthcare Provider Details

I. General information

NPI: 1720509037
Provider Name (Legal Business Name): NICOLE NAZON DONNELLY MSN, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2017
Last Update Date: 08/31/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5306 NC HIGHWAY 55 STE 105
DURHAM NC
27713-7812
US

IV. Provider business mailing address

6026 SIX FORKS RD
RALEIGH NC
27609-3899
US

V. Phone/Fax

Practice location:
  • Phone: 919-457-1517
  • Fax: 919-363-7697
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5009633
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: