Healthcare Provider Details

I. General information

NPI: 1982614764
Provider Name (Legal Business Name): RENE ROYAL CORBETT RN, MSN, APRN-BC, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 03/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 PHYSICIANS DRIVE
WILMINGTON NC
28401-7335
US

IV. Provider business mailing address

1414 PHYSICIANS DRIVE
WILMINGTON NC
28401-7335
US

V. Phone/Fax

Practice location:
  • Phone: 910-796-7900
  • Fax: 910-796-7901
Mailing address:
  • Phone: 910-796-7900
  • Fax: 910-796-7901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number600137
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: