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NPI Code Detail

MEDICARE: MRS. AUNDREA RAE EMANUEL FNP

MEDICARE: MRS. AUNDREA RAE EMANUEL FNP
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 Practitioner0050-01133NC

General Provider Information

NPI Number : 1811965692
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. AUNDREA RAE EMANUEL FNP
Provider Business Mailing Address
First Line : 5221 PARAMOUNT PKWY STE 220
Second Line :
City : MORRISVILLE
State : NC
Zip : 27560-5490
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 101 N WALNUT ST
Second Line :
City : FAIRMONT
State : NC
Zip : 28340-1951
Country : US
Telephone Number : 910-628-0655
Fax Number : 910-628-0158
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2006
Last Update Date : 03/01/2024

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