Healthcare Provider Details

I. General information

NPI: 1023518339
Provider Name (Legal Business Name): HENRY MATTHEW VANPALA NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2018
Last Update Date: 02/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1631 MIDTOWN PL STE 101
RALEIGH NC
27609-1300
US

IV. Provider business mailing address

1631 MIDTOWN PL STE 101
RALEIGH NC
27609-1300
US

V. Phone/Fax

Practice location:
  • Phone: 919-977-1675
  • Fax:
Mailing address:
  • Phone: 919-977-1675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5010294
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: