Healthcare Provider Details

I. General information

NPI: 1811739196
Provider Name (Legal Business Name): MICHEL GONZALEZ NUNEZ FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2024
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 WELTON WAY
MOORESVILLE NC
28117-9163
US

IV. Provider business mailing address

131 WELTON WAY
MOORESVILLE NC
28117-9163
US

V. Phone/Fax

Practice location:
  • Phone: 704-360-4564
  • Fax:
Mailing address:
  • Phone: 704-360-4564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5020487
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: