Healthcare Provider Details

I. General information

NPI: 1710809512
Provider Name (Legal Business Name): RUTH NOEMY CASTILLO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 WAUGHTOWN ST
WINSTON SALEM NC
27127-2236
US

IV. Provider business mailing address

1305 SOLO DR
SILER CITY NC
27344-1617
US

V. Phone/Fax

Practice location:
  • Phone: 336-515-1173
  • Fax: 336-792-1518
Mailing address:
  • Phone: 336-515-1173
  • Fax: 336-792-1518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5025039
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: