=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790394898
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PREFERRED NETWORK PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2020
-----------------------------------------------------
Last Update Date | 09/22/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 206 COMMERCE AVE
-----------------------------------------------------
City | SOUTHERN PINES
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28387-7059
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-724-0182
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10 LAKE HILLS RD
-----------------------------------------------------
City | PINEHURST
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28374-9639
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-724-0182
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NP
-----------------------------------------------------
Name | LIZA ANTON-VALDEZ
-----------------------------------------------------
Credential | DNP, MSN, NP-C
-----------------------------------------------------
Telephone | 910-724-0182
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------