=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073378162
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LUANN DAMIANI-GROCHOWSKI PMHNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/16/2024
-----------------------------------------------------
Last Update Date | 01/21/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 117 HOLDEN BEACH RD SW UNIT 108
-----------------------------------------------------
City | SHALLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28470-1787
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-629-5344
-----------------------------------------------------
Fax | 910-348-8664
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4030 WAKE FOREST RD STE 349
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27609-0010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-629-5344
-----------------------------------------------------
Fax | 910-348-8664
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 5019730
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 5019730
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------