Healthcare Provider Details

I. General information

NPI: 1780917559
Provider Name (Legal Business Name): JOHN SLOAN LYTLE RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2009
Last Update Date: 09/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 SHADY GLEN TRL
HILLSBOROUGH NC
27278-8832
US

IV. Provider business mailing address

6300 SHADY GLEN TRL
HILLSBOROUGH NC
27278-8832
US

V. Phone/Fax

Practice location:
  • Phone: 919-237-1471
  • Fax:
Mailing address:
  • Phone: 919-237-1471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0100X
TaxonomyGastroenterology Registered Nurse
License Number113774
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: