Healthcare Provider Details

I. General information

NPI: 1417947334
Provider Name (Legal Business Name): MICHELLE MERCER CANFIELD RN MSN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2005
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3403 WAKE FOREST ROAD SUITE 303
RALEIGH NC
27609
US

IV. Provider business mailing address

3404 WAKE FOREST RD STE 303
RALEIGH NC
27609-7341
US

V. Phone/Fax

Practice location:
  • Phone: 919-862-5480
  • Fax:
Mailing address:
  • Phone: 919-931-6795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201872
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: