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General NPI Number Information
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NPI Number | 1952926354
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Entity Type | Individual
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Provider Name | DAVIN O NYANGAU
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Gender | Male
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Dates
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Enumeration Date | 06/11/2020
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Last Update Date | 12/24/2020
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Provider Practice Location Address
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Address Line | 3000 NEW BERN AVE
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City | RALEIGH
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State | NC
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Zip | 27610-1231
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Country | US
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Telephone | 919-696-1567
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Fax |
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Provider Business Mailing Address
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Address Line | 100 TRAMWAY CIR
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City | ANGIER
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State | NC
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Zip | 27501-9170
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Country | US
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Telephone | 919-696-1567
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0010-10570
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License Number State | NC
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