Healthcare Provider Details

I. General information

NPI: 1780225599
Provider Name (Legal Business Name): REBECCA ELLEN WOODBURY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2019
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 MULBERRY ST SW STE 103
LENOIR NC
28645-5463
US

IV. Provider business mailing address

401 MULBERRY ST SW STE 103
LENOIR NC
28645-5463
US

V. Phone/Fax

Practice location:
  • Phone: 828-757-5916
  • Fax: 828-757-5915
Mailing address:
  • Phone: 828-757-5916
  • Fax: 828-757-5915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5012350
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: