Healthcare Provider Details

I. General information

NPI: 1841641883
Provider Name (Legal Business Name): PARISE EXQUISITE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2016
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4611 YADKIN RD
FAYETTEVILLE NC
28303-3423
US

IV. Provider business mailing address

4611 YADKIN RD
FAYETTEVILLE NC
28303-3423
US

V. Phone/Fax

Practice location:
  • Phone: 910-890-7471
  • Fax:
Mailing address:
  • Phone: 910-890-7471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MISS PORSCHE EALY
Title or Position: OWNER
Credential:
Phone: 910-890-7471