Healthcare Provider Details

I. General information

NPI: 1417129305
Provider Name (Legal Business Name): GEORGETTE FERNANDA GURA CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2008
Last Update Date: 03/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5904 SIX FORKS RD STE 111
RALEIGH NC
27609-8228
US

IV. Provider business mailing address

5904 SIX FORKS RD STE 111
RALEIGH NC
27609-8228
US

V. Phone/Fax

Practice location:
  • Phone: 919-787-9555
  • Fax: 919-510-5111
Mailing address:
  • Phone: 919-787-9555
  • Fax: 919-510-5111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number300235
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: