Healthcare Provider Details

I. General information

NPI: 1376968487
Provider Name (Legal Business Name): MAGGIE WHITT MAZUREK FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAGGIE LAUREN WHITT

II. Dates (important events)

Enumeration Date: 02/26/2014
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 HAWTHORNE DR
INDIAN TRAIL NC
28079-4135
US

IV. Provider business mailing address

1150 HAWTHORNE DR
INDIAN TRAIL NC
28079-4135
US

V. Phone/Fax

Practice location:
  • Phone: 980-999-0466
  • Fax: 704-704-1053
Mailing address:
  • Phone: 980-999-0466
  • Fax: 704-704-1053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number246723
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5007328
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5007328
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number24007
License Number StateSC
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberC-APN.0107911-C-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: