Healthcare Provider Details

I. General information

NPI: 1013669654
Provider Name (Legal Business Name): NUTRADRIP IV HYDRATION & WELLNESS CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2022
Last Update Date: 02/02/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4049 CAPITAL DR
ROCKY MOUNT NC
27804-3123
US

IV. Provider business mailing address

4049 CAPITAL DR
ROCKY MOUNT NC
27804-3123
US

V. Phone/Fax

Practice location:
  • Phone: 252-443-3550
  • Fax: 252-443-3590
Mailing address:
  • Phone: 252-443-3550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LATOYA MCCURDY
Title or Position: CEO/ PRESIDENT
Credential: FNP-BC
Phone: 252-314-7087