Healthcare Provider Details

I. General information

NPI: 1316720139
Provider Name (Legal Business Name): CARA PETERSON MEDLIN BSN, RN, CCRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2023
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 NEW BERN AVE
RALEIGH NC
27610-1231
US

IV. Provider business mailing address

3711 EXCHANGE GLENWOOD PL UNIT 170
RALEIGH NC
27612-4882
US

V. Phone/Fax

Practice location:
  • Phone: 919-350-8000
  • Fax:
Mailing address:
  • Phone: 919-306-1186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number333554
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: