Healthcare Provider Details

I. General information

NPI: 1043437775
Provider Name (Legal Business Name): VICTOR CONRAD PAQUIN F.P.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 FERN CREEK DR
STATESVILLE NC
28625-9376
US

IV. Provider business mailing address

PO BOX 5105
BELFAST ME
04915-5100
US

V. Phone/Fax

Practice location:
  • Phone: 828-459-6824
  • Fax: 828-330-2056
Mailing address:
  • Phone: 919-220-5255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number201475
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: