Provider Demographics
NPI:1033358213
Name:ACT MEDICAL
Entity Type:Organization
Organization Name:ACT MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAVIS
Authorized Official - Middle Name:OSEI
Authorized Official - Last Name:YEBOAH
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:336-358-0033
Mailing Address - Street 1:311 JUDGES RD STE 4E
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-3655
Mailing Address - Country:US
Mailing Address - Phone:910-791-6767
Mailing Address - Fax:910-791-8490
Practice Address - Street 1:311 JUDGES RD STE 4E
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-3655
Practice Address - Country:US
Practice Address - Phone:910-791-6767
Practice Address - Fax:910-791-8490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004181261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care