Healthcare Provider Details

I. General information

NPI: 1174799746
Provider Name (Legal Business Name): ELIZABETH ANN HOUSTON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2008
Last Update Date: 05/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 RUIN CREEK RD STE 101
HENDERSON NC
27536-5919
US

IV. Provider business mailing address

7317 MASSACHUSETTS COURT
RALEIGH NC
27615
US

V. Phone/Fax

Practice location:
  • Phone: 252-492-8576
  • Fax:
Mailing address:
  • Phone: 804-512-8353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number207411
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: