Healthcare Provider Details

I. General information

NPI: 1497565915
Provider Name (Legal Business Name): STEPHONIE NICOLE UTLEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2025
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 NEUSE BLVD
NEW BERN NC
28560-3449
US

IV. Provider business mailing address

1145 CAMPBELL RD
VANCEBORO NC
28586-7655
US

V. Phone/Fax

Practice location:
  • Phone: 252-633-8111
  • Fax:
Mailing address:
  • Phone: 252-671-1623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number263525
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: