Healthcare Provider Details

I. General information

NPI: 1972136331
Provider Name (Legal Business Name): LATESHA PAIT ZURCHER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LATESHA DAWN PAIT

II. Dates (important events)

Enumeration Date: 02/13/2020
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 LIBERTY HILL RD
LUMBERTON NC
28358-2446
US

IV. Provider business mailing address

4676 REGAN CHURCH RD
LUMBERTON NC
28358-7575
US

V. Phone/Fax

Practice location:
  • Phone: 910-739-3318
  • Fax: 910-671-3600
Mailing address:
  • Phone: 910-316-1474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number501294
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number501294
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number194716
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: