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General NPI Number Information
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NPI Number | 1568654903
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Entity Type | Individual
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Provider Name | MALINDA TEAGUE CPNP
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Gender | Female
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Dates
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Enumeration Date | 08/09/2007
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Last Update Date | 03/16/2021
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Provider Practice Location Address
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Address Line | 2406 BLUE RIDGE RD STE 100
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City | RALEIGH
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State | NC
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Zip | 27607
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Country | US
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Telephone | 919-786-5001
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Fax | 919-786-5051
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Provider Business Mailing Address
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Address Line | 5213 S ALSTON AVE
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City | DURHAM
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State | NC
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Zip | 27713-4430
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Country | US
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Telephone | 919-620-4855
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Fax | 919-620-4921
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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 | 250343
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 209-004496
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License Number State | IL
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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 | 5010373
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 286171
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License Number State | NC
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