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General NPI Number Information
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NPI Number | 1245733773
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Entity Type | Individual
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Provider Name | PATERA ANITRA FOYE-FULLER PNP
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Gender | Female
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Dates
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Enumeration Date | 03/12/2018
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Last Update Date | 03/12/2018
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Provider Practice Location Address
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Address Line | 110 LATTNER CT STE 100
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City | MORRISVILLE
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State | NC
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Zip | 27560-6843
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Country | US
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Telephone | 919-462-6206
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Fax | 919-462-6207
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Provider Business Mailing Address
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Address Line | 228 MUSES MILL CT
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City | HOLLY SPRINGS
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State | NC
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Zip | 27540-7947
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Country | US
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Telephone | 919-819-8266
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 5010341
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License Number State | NC
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