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General NPI Number Information
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NPI Number | 1013669654
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Entity Type | Organization
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Legal Business Name | NUTRADRIP IV HYDRATION & WELLNESS CLINIC, PLLC
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Dates
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Enumeration Date | 01/25/2022
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Last Update Date | 02/02/2022
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Provider Practice Location Address
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Address Line | 4049 CAPITAL DR
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-3123
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Country | US
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Telephone | 252-443-3550
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Fax | 252-443-3590
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Provider Business Mailing Address
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Address Line | 4049 CAPITAL DR
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-3123
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Country | US
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Telephone | 252-443-3550
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Fax |
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Authorized Official
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Title or Position | CEO/ PRESIDENT
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Name | LATOYA MCCURDY
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Credential | FNP-BC
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Telephone | 252-314-7087
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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