Healthcare Provider Details

I. General information

NPI: 1538771795
Provider Name (Legal Business Name): MICHELLE RENEE MUHAMMAD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2020
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 DAWN DR STE 3300
LUMBERTON NC
28360-8288
US

IV. Provider business mailing address

442 TARTAN CT
FAYETTEVILLE NC
28311-1694
US

V. Phone/Fax

Practice location:
  • Phone: 910-671-9298
  • Fax: 910-671-4850
Mailing address:
  • Phone: 910-257-7618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5014091
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberMUHA-WX014
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: