Healthcare Provider Details

I. General information

NPI: 1023872751
Provider Name (Legal Business Name): DIAMOND NOWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 E BROAD ST
SAINT PAULS NC
28384-1610
US

IV. Provider business mailing address

60 COMMERCE PLAZA CIR
PEMBROKE NC
28372-7386
US

V. Phone/Fax

Practice location:
  • Phone: 910-241-3042
  • Fax: 910-241-3462
Mailing address:
  • Phone: 910-521-2900
  • Fax: 910-775-9165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number5021246
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: