Healthcare Provider Details

I. General information

NPI: 1942951785
Provider Name (Legal Business Name): RACHEL DYRHAUG FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2022
Last Update Date: 11/03/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3803 N ELM ST
GREENSBORO NC
27455-2593
US

IV. Provider business mailing address

8508 HIGHGATE DR
CHARLOTTE NC
28215-2796
US

V. Phone/Fax

Practice location:
  • Phone: 855-247-8474
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number344105
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1096151
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5017142
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: