Healthcare Provider Details

I. General information

NPI: 1255152898
Provider Name (Legal Business Name): OLIVIA FAYE VOGEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 US 70 HWY E
GARNER NC
27529-3982
US

IV. Provider business mailing address

50 HIGHLAND WOOD DR
CLAYTON NC
27527-8639
US

V. Phone/Fax

Practice location:
  • Phone: 919-791-5611
  • Fax: 919-342-8393
Mailing address:
  • Phone: 215-749-2183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number319691
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5021062
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: