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General NPI Number Information
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NPI Number | 1669928776
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Entity Type | Individual
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Provider Name | ALISSA NATALIE BINFORD PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/29/2016
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Last Update Date | 12/02/2016
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Provider Practice Location Address
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Address Line | 2936 N ELM ST SUITE #102
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City | LUMBERTON
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State | NC
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Zip | 28358-2981
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Country | US
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Telephone | 910-671-6619
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 63362
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City | CHARLOTTE
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State | NC
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Zip | 28263-3362
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Country | US
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Telephone | 919-620-4700
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-06683
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 0010-06683
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License Number State | NC
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