Healthcare Provider Details

I. General information

NPI: 1518942135
Provider Name (Legal Business Name): MARJORIE R RACHIDE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 08/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SOUTH CAREY STREET
LAGRANGE NC
28551
US

IV. Provider business mailing address

701 DOCTORS DRIVE SUITE N
KINSTON NC
28501
US

V. Phone/Fax

Practice location:
  • Phone: 252-566-4021
  • Fax: 252-566-2902
Mailing address:
  • Phone: 252-559-2200
  • Fax: 252-522-5662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number200758
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: