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General NPI Number Information
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NPI Number | 1134870066
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Entity Type | Individual
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Provider Name | FREDERICO JOSE REIS SOARES
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Gender | Male
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Dates
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Enumeration Date | 01/12/2022
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Last Update Date | 01/13/2022
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Provider Practice Location Address
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Address Line | 1021 MOREHEAD MEDICAL DR
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City | CHARLOTTE
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State | NC
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Zip | 28204-2990
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Country | US
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Telephone | 980-442-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 105 W C ST
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City | BECKLEY
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State | WV
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Zip | 25801-5502
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Country | US
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Telephone | 570-561-7901
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 5015542
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License Number State | NC
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