Healthcare Provider Details

I. General information

NPI: 1912934159
Provider Name (Legal Business Name): FAYE WELDON LYNCH RN PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 02/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

544 W RIDGEWAY ST WARREN CO HEALTH DEPT
WARRENTON NC
27589
US

IV. Provider business mailing address

1100 CHURCH HILL RD
MACON NC
27551
US

V. Phone/Fax

Practice location:
  • Phone: 252-257-1185
  • Fax: 252-257-4867
Mailing address:
  • Phone: 252-257-3780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number056930
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number300310
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: