Healthcare Provider Details

I. General information

NPI: 1558844340
Provider Name (Legal Business Name): ALPHONZA FAISON JR. FNP, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2018
Last Update Date: 03/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 W MARKET ST STE 108
GREENSBORO NC
27409
US

IV. Provider business mailing address

307 VILLAGE LN UNIT B
GREENSBORO NC
27409-2532
US

V. Phone/Fax

Practice location:
  • Phone: 336-622-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number247595
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberFAIS-PZ4Z48
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5011127
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: