Healthcare Provider Details

I. General information

NPI: 1306214820
Provider Name (Legal Business Name): SATOYA DUBOSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2015
Last Update Date: 02/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 BERWICK DR STE A
LAURINBURG NC
28352-5543
US

IV. Provider business mailing address

5351 TERRY RD
CLIO SC
29525-4235
US

V. Phone/Fax

Practice location:
  • Phone: 910-276-2439
  • Fax:
Mailing address:
  • Phone: 864-710-0351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5007966
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: