MEDICARE: LORIE TYSON COLLIER 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	363LA2200X	Adult Health Nurse Practitioner	5006060	NC

General Provider Information

NPI Number	:	1578803219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORIE TYSON COLLIER ANP

Provider Business Mailing Address
First Line	:	3700 BARRETT DR STE 200
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27609-7172
Country	:	US
Telephone Number	:	919-231-3966
Fax Number	:	919-231-3912

Provider Business Practice Location Address
First Line	:	2503 WOOTEN BLVD SW
Second Line	:
City	:	WILSON
State	:	NC
Zip	:	27893-4426
Country	:	US
Telephone Number	:	252-243-2268
Fax Number	:

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

Provider Enumeration Date	:	02/17/2013
Last Update Date	:	01/27/2025

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