Healthcare Provider Details

I. General information

NPI: 1003888306
Provider Name (Legal Business Name): DEBRA LYNNE MINOR-SCHORK RN MSN CS B.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 S. BROAD ST. STE. 1
EDENTON NC
27932
US

IV. Provider business mailing address

407 S. BROAD ST. STE. 1
EDENTON NC
27932
US

V. Phone/Fax

Practice location:
  • Phone: 252-562-8833
  • Fax: 252-482-1055
Mailing address:
  • Phone: 252-562-8833
  • Fax: 252-482-1055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number147129-01
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number100093
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: