Healthcare Provider Details

I. General information

NPI: 1124584610
Provider Name (Legal Business Name): CAROLINE C. OBREGON AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2019
Last Update Date: 10/13/2024
Certification Date: 10/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3012 FALSTAFF RD
RALEIGH NC
27610-1813
US

IV. Provider business mailing address

1913 E FIRE TOWER RD
GREENVILLE NC
27858-4126
US

V. Phone/Fax

Practice location:
  • Phone: 919-615-1027
  • Fax:
Mailing address:
  • Phone: 252-375-4380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5011531
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: