Healthcare Provider Details

I. General information

NPI: 1629790019
Provider Name (Legal Business Name): NAOMI LYLE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2022
Last Update Date: 09/07/2025
Certification Date: 09/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3643 N ROXBORO ST
DURHAM NC
27704-2702
US

IV. Provider business mailing address

603 WATTS ST APT 3
DURHAM NC
27701-1745
US

V. Phone/Fax

Practice location:
  • Phone: 919-470-4000
  • Fax:
Mailing address:
  • Phone: 907-699-6655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number8016
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: