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General NPI Number Information
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NPI Number | 1659089076
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Entity Type | Individual
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Provider Name | NICOLE MARIE JUSTUS FNP-C
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Gender | Female
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Dates
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Enumeration Date | 11/15/2022
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 518 OLD US 221 HWY N
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City | RUTHERFORDTON
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State | NC
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Zip | 28139-8670
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Country | US
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Telephone | 828-920-8902
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Fax | 630-216-7177
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Provider Business Mailing Address
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Address Line | 109 MEADOWCREST DR
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City | FLAT ROCK
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State | NC
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Zip | 28731-9770
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Country | US
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Telephone | 828-920-8902
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 5017275
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License Number State | NC
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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 | 5017275
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License Number State | NC
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