Healthcare Provider Details

I. General information

NPI: 1588092399
Provider Name (Legal Business Name): OCEANSIDE FAMILY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2013
Last Update Date: 10/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5145 SELLERS RD
SHALLOTTE NC
28470-3405
US

IV. Provider business mailing address

5145 SELLERS RD
SHALLOTTE NC
28470-3405
US

V. Phone/Fax

Practice location:
  • Phone: 910-754-4441
  • Fax:
Mailing address:
  • Phone: 910-754-4441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5006519
License Number StateNC

VIII. Authorized Official

Name: CATHERINE SWAIN
Title or Position: NURSE PRACTITIONER
Credential: FNP-C
Phone: 910-409-1658