Healthcare Provider Details

I. General information

NPI: 1669191920
Provider Name (Legal Business Name): MORGAN BULLA LAZORCHICK FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2022
Last Update Date: 08/22/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 BRASCOTE LN
WILMINGTON NC
28412-8202
US

IV. Provider business mailing address

213 BRASCOTE LN
WILMINGTON NC
28412-8202
US

V. Phone/Fax

Practice location:
  • Phone: 910-297-4859
  • Fax:
Mailing address:
  • Phone: 910-297-4859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF08220191
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: