=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407196181
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PATRICIA WAGONER CLAPP RN, ANP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/18/2013
-----------------------------------------------------
Last Update Date | 02/18/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 906 N ANTHONY ST
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27217-6663
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-228-2433
-----------------------------------------------------
Fax | 336-335-1770
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O. BOX 691
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27216-0691
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-228-2433
-----------------------------------------------------
Fax | 336-335-1770
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | 041213
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------