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General NPI Number Information
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NPI Number | 1235595927
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Entity Type | Organization
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Legal Business Name | THE CLINIC AT WALMART
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Dates
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Enumeration Date | 01/11/2016
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Last Update Date | 01/11/2016
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Provider Practice Location Address
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Address Line | 5070 FAYETTEVILLE RD
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City | LUMBERTON
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State | NC
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Zip | 28358-2108
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Country | US
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Telephone | 910-739-0133
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Fax |
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Provider Business Mailing Address
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Address Line | 341 SANDSTONE RD
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City | RED SPRINGS
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State | NC
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Zip | 28377-6469
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Country | US
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Telephone | 910-736-7002
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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 | MRS. LISA HERSHBERGER
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Credential | FNP
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Telephone | 910-736-7002
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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 | 196391
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License Number State | NC
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