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General NPI Number Information
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NPI Number | 1881409076
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Entity Type | Organization
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Legal Business Name | MOORE STREET PULMONARY CLINIC, PLLC
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Dates
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Enumeration Date | 02/12/2025
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Last Update Date | 08/09/2025
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Provider Practice Location Address
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Address Line | 439 MOORE ST
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City | FAYETTEVILLE
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State | NC
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Zip | 28301-4863
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Country | US
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Telephone | 910-257-4371
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Fax |
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Provider Business Mailing Address
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Address Line | 439 MOORE ST
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City | FAYETTEVILLE
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State | NC
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Zip | 28301-4863
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Country | US
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Telephone | 910-257-4371
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Fax | 910-257-4371
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | ROSE MARY GRAHAM
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Credential | ACNP-BC
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Telephone | 910-257-4371
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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