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General NPI Number Information
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NPI Number | 1881916385
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Entity Type | Organization
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Legal Business Name | WHITE LAKE FAMILY PRACTICE, PLLC
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Dates
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Enumeration Date | 02/24/2010
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Last Update Date | 02/24/2010
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Provider Practice Location Address
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Address Line | 1921 WHITE LAKE DR
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City | ELIZABETHTOWN
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State | NC
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Zip | 28337-6236
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Country | US
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Telephone | 910-862-6491
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Fax | 910-862-7641
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Provider Business Mailing Address
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Address Line | 1921 WHITE LAKE DR
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City | ELIZABETHTOWN
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State | NC
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Zip | 28337-6236
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Country | US
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Telephone | 910-862-6491
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Fax | 910-862-7641
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER/OWNER
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Name | MRS. PEGGY HILL NEWMAN
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Credential | FNP-C
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Telephone | 910-862-6491
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 201247
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License Number State | NC
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