=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710417852
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LOIS JOYCE ROBERSON FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2017
-----------------------------------------------------
Last Update Date | 06/12/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1032 US HIGHWAY 64 E
-----------------------------------------------------
City | PLYMOUTH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27962-9215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 242-793-4500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 158
-----------------------------------------------------
City | JAMESVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27846-0158
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 5009564
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------