MEDICARE: MAGNOLIA WOMEN'S HEALTH

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	NC800141	NC

General Provider Information

NPI Number	:	1952365868
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAGNOLIA WOMEN'S HEALTH

Provider Business Mailing Address
First Line	:	1100 HOLLY SPRINGS RD
Second Line	:
City	:	HOLLY SPRINGS
State	:	NC
Zip	:	27540-9469
Country	:	US
Telephone Number	:	919-552-1457
Fax Number	:	919-552-1369

Provider Business Practice Location Address
First Line	:	1100 HOLLY SPRINGS RD
Second Line	:
City	:	HOLLY SPRINGS
State	:	NC
Zip	:	27540-9469
Country	:	US
Telephone Number	:	919-552-1457
Fax Number	:	919-552-1369

Authorized Official
Title or Position	:	WHNP
Name	:	MS. JULIE ANN KEELER
Credential	:	MSN
Telephone Number	:	919-552-1457

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	08/22/2020

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Directions to “MAGNOLIA WOMEN'S HEALTH ” Practice Location

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