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NPI Code Detail

MEDICARE: JANE GRACE FNP-C

MEDICARE: JANE GRACE FNP-C
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
1363LF0000XFamily Nurse Practitioner5004382NC

General Provider Information

NPI Number : 1346475837
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANE GRACE FNP-C
Provider Business Mailing Address
First Line : 3070 11TH AVENUE DR SE
Second Line :
City : HICKORY
State : NC
Zip : 28602-8336
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2501 HOMESTEAD RD
Second Line :
City : CHAPEL HILL
State : NC
Zip : 27516-9087
Country : US
Telephone Number : 919-245-2400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2009
Last Update Date : 08/04/2020

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