Healthcare Provider Details

I. General information

NPI: 1053500363
Provider Name (Legal Business Name): DEBORAH HUPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 12/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 EAST ROOSEVELT AVE MINUTECLINIC DIAGNOSTIC OF NORTH CAROLINA
WAKE FOREST NC
27587
US

IV. Provider business mailing address

9305 GLAMIS CIR
WAKE FOREST NC
27587-1648
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax: 401-652-9787
Mailing address:
  • Phone: 919-453-1640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number84271
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: