Healthcare Provider Details

I. General information

NPI: 1144968959
Provider Name (Legal Business Name): FOLASHADE RUTH PASEDA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2022
Last Update Date: 10/04/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S MAIN ST STE 100
REIDSVILLE NC
27320-5034
US

IV. Provider business mailing address

798 AVALON SPRINGS CT
HIGH POINT NC
27265-2914
US

V. Phone/Fax

Practice location:
  • Phone: 336-951-6460
  • Fax:
Mailing address:
  • Phone: 336-457-3280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF06221897
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5016575
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number288927
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: