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General NPI Number Information
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NPI Number | 1548798150
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Entity Type | Individual
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Provider Name | LIZETH JOANNA REGO BANUCHI APRN
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Gender | Female
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Dates
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Enumeration Date | 05/25/2017
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Last Update Date | 11/13/2025
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Provider Practice Location Address
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Address Line | 2340 SPRING FOREST RD
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City | RALEIGH
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State | NC
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Zip | 27615-7528
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Country | US
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Telephone | 866-398-2727
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Fax |
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Provider Business Mailing Address
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Address Line | 436 AIRPORT RD
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City | ARDEN
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State | NC
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Zip | 28704-8403
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Country | US
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Telephone | 828-650-7282
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APN0000022625
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP004143
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 5019618
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License Number State | NC
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