Healthcare Provider Details

I. General information

NPI: 1982254751
Provider Name (Legal Business Name): STEPHANIE MCAULEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2019
Last Update Date: 09/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 BRUCEWOOD RD
SOUTHERN PINES NC
28387-5143
US

IV. Provider business mailing address

1784 LOBELIA RD
VASS NC
28394-9146
US

V. Phone/Fax

Practice location:
  • Phone: 910-405-1161
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5012264
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: