MEDICARE: LORRAINE L WAGUESPACK F.N.P.

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	363LF0000X	Family Nurse Practitioner	AN76390	NC

General Provider Information

NPI Number	:	1689609976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORRAINE L WAGUESPACK F.N.P.

Provider Business Mailing Address
First Line	:	1502 W NC HIGHWAY 54
Second Line	:	STE 103
City	:	DURHAM
State	:	NC
Zip	:	27707-5572
Country	:	US
Telephone Number	:	919-354-0840
Fax Number	:	919-748-4441

Provider Business Practice Location Address
First Line	:	4037 DURHAM CHAPEL HILL BLVD
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27707-2516
Country	:	US
Telephone Number	:	919-966-4996
Fax Number	:	919-843-5515

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	04/23/2019

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