Healthcare Provider Details

I. General information

NPI: 1801287057
Provider Name (Legal Business Name): GROWING CHILD PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2015
Last Update Date: 02/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 E HORTON ST
ZEBULON NC
27597-2820
US

IV. Provider business mailing address

260 HORIZON DR
RALEIGH NC
27615-4922
US

V. Phone/Fax

Practice location:
  • Phone: 919-269-2885
  • Fax: 919-488-1718
Mailing address:
  • Phone: 919-488-0015
  • Fax: 919-277-0066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number5007449
License Number StateNC

VIII. Authorized Official

Name: MONICA MOSKO
Title or Position: NURSE PRACTITIONER
Credential:
Phone: 419-779-1896