Healthcare Provider Details

I. General information

NPI: 1104572452
Provider Name (Legal Business Name): AMIE RENAE MOTLEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2022
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2412 WILKINS DR
SANFORD NC
27330-7268
US

IV. Provider business mailing address

2300 CAPE JASMINE DR
SANFORD NC
27330-9464
US

V. Phone/Fax

Practice location:
  • Phone: 919-776-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberMOTL-MXRMG
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: