MEDICARE: LINDSAY PENN SCRUGGS

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	363LW0102X	Women's Health Nurse Practitioner	5004855	NC

General Provider Information

NPI Number	:	1396053534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDSAY PENN SCRUGGS

Provider Business Mailing Address
First Line	:	2609 N DUKE ST STE 204
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27704-5936
Country	:	US
Telephone Number	:	919-220-5435
Fax Number	:

Provider Business Practice Location Address
First Line	:	4414 LAKE BOONE TRL STE 210
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27607-7520
Country	:	US
Telephone Number	:	919-671-1040
Fax Number	:

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

Provider Enumeration Date	:	09/22/2010
Last Update Date	:	11/16/2021

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