Healthcare Provider Details

I. General information

NPI: 1073979480
Provider Name (Legal Business Name): ANNA RUSLANOVNA DEGOLIER APRN-C, AGNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA MOBLEY

II. Dates (important events)

Enumeration Date: 01/14/2016
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7920 ACC BLVD STE 300
RALEIGH NC
27617-8744
US

IV. Provider business mailing address

7920 ACC BLVD STE 300
RALEIGH NC
27617-8744
US

V. Phone/Fax

Practice location:
  • Phone: 919-908-0000
  • Fax: 919-596-6147
Mailing address:
  • Phone: 919-908-0000
  • Fax: 919-596-6147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5017297
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN2051
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: