Healthcare Provider Details

I. General information

NPI: 1578256160
Provider Name (Legal Business Name): MICHELLE SEPE TABILI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2023
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

759 TWICKENHAM LN
WINSTON SALEM NC
27127-5991
US

IV. Provider business mailing address

759 TWICKENHAM LN
WINSTON SALEM NC
27127-5991
US

V. Phone/Fax

Practice location:
  • Phone: 743-444-8932
  • Fax:
Mailing address:
  • Phone: 743-444-8932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number327445
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number327445
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: