1215011028 NPI number — VONDA REIVES FNP-C

Table of content: VONDA REIVES FNP-C (NPI 1215011028)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215011028 NPI number — VONDA REIVES FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REIVES
Provider First Name:
VONDA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215011028
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 S MIDDLETON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROBBINS
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27325-8407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-948-2059
Provider Business Mailing Address Fax Number:
910-948-2443

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 S MIDDLETON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROBBINS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27325-8407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-948-2059
Provider Business Practice Location Address Fax Number:
910-948-2443
Provider Enumeration Date:
10/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  201805 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 201805 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP2300X , with the licence number: 201805 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 080153048 . This is a "RR MEDICARE-SANFORD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 51232 . This is a "MEDCOST-SANFORD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8984267 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 84267 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 080065783 . This is a "RR MEDICARE-PITTSBORO" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 31985 . This is a "MEDCOST-PITTSBORO" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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