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General NPI Number Information
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NPI Number | 1013624394
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Entity Type | Organization
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Legal Business Name | THE MAN CAVE TESTOSTERONE AND WELLNESS, PLLC
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Dates
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Enumeration Date | 11/04/2022
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Last Update Date | 11/04/2022
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Provider Practice Location Address
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Address Line | 2816 W BROAD ST
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City | ELIZABETHTOWN
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State | NC
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Zip | 28337-9245
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Country | US
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Telephone | 910-801-0600
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 512
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City | DUBLIN
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State | NC
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Zip | 28332-0512
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Country | US
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Telephone | 910-991-5703
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Fax |
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER
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Name | DR. CRYSTAL M ROGERS
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Credential | DNP
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Telephone | 910-801-0600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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