Healthcare Provider Details

I. General information

NPI: 1770059941
Provider Name (Legal Business Name): CIARA NICOLE BRANCH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2018
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 DAWN DR STE 3100
LUMBERTON NC
28360-0007
US

IV. Provider business mailing address

2002 N CEDAR ST STE B
LUMBERTON NC
28358-3926
US

V. Phone/Fax

Practice location:
  • Phone: 910-671-8556
  • Fax: 910-671-4850
Mailing address:
  • Phone: 910-272-3048
  • Fax: 910-738-3764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number216945
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: