Healthcare Provider Details

I. General information

NPI: 1396053534
Provider Name (Legal Business Name): LINDSAY PENN SCRUGGS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2010
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4414 LAKE BOONE TRL STE 210
RALEIGH NC
27607-7520
US

IV. Provider business mailing address

2609 N DUKE ST STE 204
DURHAM NC
27704-5936
US

V. Phone/Fax

Practice location:
  • Phone: 919-671-1040
  • Fax:
Mailing address:
  • Phone: 919-220-5435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number5004855
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: