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General NPI Number Information
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NPI Number | 1598121642
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Entity Type | Organization
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Legal Business Name | CAPE LOOKOUT PRIMARY CARE, PC
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Dates
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Enumeration Date | 01/05/2016
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Last Update Date | 01/05/2016
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Provider Practice Location Address
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Address Line | 345 HWY 70 OTWAY
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City | BEAUFORT
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State | NC
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Zip | 28516-6521
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Country | US
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Telephone | 252-838-2023
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Fax | 800-889-3341
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Provider Business Mailing Address
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Address Line | 345 HWY 70 OTWAY
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City | BEAUFORT
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State | NC
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Zip | 28516-6521
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Country | US
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Telephone | 252-838-2023
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Fax | 800-889-3341
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Authorized Official
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Title or Position | OWNER
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Name | NANCY GURGANUS
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Credential | NP
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Telephone | 252-646-0998
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 5006123
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License Number State | NC
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