MEDICARE: MRS. MICHELE MINTZ POPULUS 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
1	163W00000X	Registered Nurse	224391	NC
2	363L00000X	Nurse Practitioner	5016015	NC

General Provider Information

NPI Number	:	1447908488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICHELE MINTZ POPULUS FNP-C

Provider Business Mailing Address
First Line	:	1202 MEDICAL CENTER DR
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28401-7307
Country	:	US
Telephone Number	:	910-341-3300
Fax Number	:

Provider Business Practice Location Address
First Line	:	8090 MARKET ST
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28411-0012
Country	:	US
Telephone Number	:	910-341-3300
Fax Number	:

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

Provider Enumeration Date	:	03/17/2022
Last Update Date	:	01/11/2023

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