Provider Demographics
NPI:1043832454
Name:VERHAEGHE, IAN FRANK MARC
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:FRANK MARC
Last Name:VERHAEGHE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 DEERFIELD ESTATES RD
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-4192
Mailing Address - Country:US
Mailing Address - Phone:919-623-8709
Mailing Address - Fax:
Practice Address - Street 1:331 DEERFIELD ESTATES RD
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4192
Practice Address - Country:US
Practice Address - Phone:919-623-8709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-08
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC296371163W00000X
NC5013164363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse