Healthcare Provider Details

I. General information

NPI: 1649057068
Provider Name (Legal Business Name): YUNIE GRACE PAK DNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 OWEN DR STE 201
FAYETTEVILLE NC
28304-3490
US

IV. Provider business mailing address

413 OWEN DR STE 201
FAYETTEVILLE NC
28304-3490
US

V. Phone/Fax

Practice location:
  • Phone: 910-323-9111
  • Fax:
Mailing address:
  • Phone: 910-323-9111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5024038
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number325080
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: