Provider Demographics
NPI:1003208349
Name:PRICE, MARVA (FNP)
Entity Type:Individual
Prefix:
First Name:MARVA
Middle Name:
Last Name:PRICE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 FEARRINGTON POST
Mailing Address - Street 2:
Mailing Address - City:PITTSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27312-8559
Mailing Address - Country:US
Mailing Address - Phone:919-810-6971
Mailing Address - Fax:
Practice Address - Street 1:2222 SOUTH FAYETTEVILLE STREET
Practice Address - Street 2:RANDOLPH COUNTY HEALTH DEPARTMENT
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27205
Practice Address - Country:US
Practice Address - Phone:336-318-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC049064363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1720011729Medicaid