Healthcare Provider Details

I. General information

NPI: 1265297808
Provider Name (Legal Business Name): LIEL JENNY ERDEDI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

695 W FLEMING DR
MORGANTON NC
28655-4450
US

IV. Provider business mailing address

5221 PARAMOUNT PKWY STE 420
MORRISVILLE NC
27560-5491
US

V. Phone/Fax

Practice location:
  • Phone: 828-580-3278
  • Fax:
Mailing address:
  • Phone: 984-974-2705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5021084
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: