=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144595828
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARGARET GORIS FNP-BC, MSN(R)
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2012
-----------------------------------------------------
Last Update Date | 12/09/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1748 HERITAGE CENTER DR STE 101
-----------------------------------------------------
City | WAKE FOREST
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27587-9855
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-529-5920
-----------------------------------------------------
Fax | 919-529-5933
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1748 HERITAGE CENTER DR STE 101
-----------------------------------------------------
City | WAKE FOREST
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27587-9855
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-529-5920
-----------------------------------------------------
Fax | 919-529-5933
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 23465
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 5020414
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------