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General NPI Number Information
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NPI Number | 1477344992
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Entity Type | Organization
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Legal Business Name | VYBEMED DIRECT PRIMARY CARE, PLLC
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Dates
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Enumeration Date | 05/14/2025
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 11 UNION ST S STE 102
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City | CONCORD
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State | NC
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Zip | 28025-1001
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Country | US
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Telephone | 704-743-4371
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2757
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City | DURHAM
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State | NC
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Zip | 27715-2757
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Country | US
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Telephone | 704-743-4371
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARIE-JACQUES MARILYN AMBROISE
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Credential | PA-C
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Telephone | 704-743-4371
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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