MEDICARE: MRS. PATERA ANITRA FOYE-FULLER PNP

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	363LP0200X	Pediatric Nurse Practitioner	5010341	NC

General Provider Information

NPI Number	:	1245733773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PATERA ANITRA FOYE-FULLER PNP

Provider Business Mailing Address
First Line	:	228 MUSES MILL CT
Second Line	:
City	:	HOLLY SPRINGS
State	:	NC
Zip	:	27540-7947
Country	:	US
Telephone Number	:	919-819-8266
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 LATTNER CT STE 100
Second Line	:
City	:	MORRISVILLE
State	:	NC
Zip	:	27560-6843
Country	:	US
Telephone Number	:	919-462-6206
Fax Number	:	919-462-6207

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

Provider Enumeration Date	:	03/12/2018
Last Update Date	:	03/12/2018

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