MEDICARE: JEWELL S MABERY ANP

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	363L00000X	Nurse Practitioner	900215	NC

General Provider Information

NPI Number	:	1073557773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEWELL S MABERY ANP

Provider Business Mailing Address
First Line	:	616 WESTSIDE DR
Second Line	:
City	:	NEWTON
State	:	NC
Zip	:	28658-3622
Country	:	US
Telephone Number	:	828-465-2719
Fax Number	:

Provider Business Practice Location Address
First Line	:	3125 POPLARWOOD CT
Second Line	:	ASPEN BLDG, SUITE 100
City	:	RALEIGH
State	:	NC
Zip	:	27604-1084
Country	:	US
Telephone Number	:	800-632-6074
Fax Number	:	866-341-7509

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

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	07/08/2007

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