Healthcare Provider Details

I. General information

NPI: 1366503468
Provider Name (Legal Business Name): PATRICIA BLANCHARD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 08/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S SYCAMORE ST
ROSE HILL NC
28458-0040
US

IV. Provider business mailing address

108 CHURCH STREET PO BOX 580
ROSE HILL NC
28458
US

V. Phone/Fax

Practice location:
  • Phone: 910-289-3027
  • Fax: 910-289-2894
Mailing address:
  • Phone: 910-289-3215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200248
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: