Healthcare Provider Details

I. General information

NPI: 1558095414
Provider Name (Legal Business Name): MATTHEW PAUL NORMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 N ARENDELL AVE
ZEBULON NC
27597-8730
US

IV. Provider business mailing address

3709 COACH LANTERN AVE
WAKE FOREST NC
27587-3404
US

V. Phone/Fax

Practice location:
  • Phone: 919-235-1965
  • Fax:
Mailing address:
  • Phone: 919-610-2360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-13956
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: