MEDICARE: PETER NGOSONG PSYCHIATRIC NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	5015437	NC

General Provider Information

NPI Number	:	1063839892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER NGOSONG PSYCHIATRIC NP

Provider Business Mailing Address
First Line	:	104 NEW STATESIDE DR
Second Line	:
City	:	CHAPEL HILL
State	:	NC
Zip	:	27516-1213
Country	:	US
Telephone Number	:	919-942-2803
Fax Number	:

Provider Business Practice Location Address
First Line	:	104 NEW STATESIDE DR
Second Line	:
City	:	CHAPEL HILL
State	:	NC
Zip	:	27516-1213
Country	:	US
Telephone Number	:	919-942-2803
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2014
Last Update Date	:	01/18/2022

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