Provider Demographics
NPI:1598121642
Name:CAPE LOOKOUT PRIMARY CARE, PC
Entity Type:Organization
Organization Name:CAPE LOOKOUT PRIMARY CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:GURGANUS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:252-646-0998
Mailing Address - Street 1:345 HWY 70 OTWAY
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:NC
Mailing Address - Zip Code:28516-6521
Mailing Address - Country:US
Mailing Address - Phone:252-838-2023
Mailing Address - Fax:800-889-3341
Practice Address - Street 1:345 HWY 70 OTWAY
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:NC
Practice Address - Zip Code:28516-6521
Practice Address - Country:US
Practice Address - Phone:252-838-2023
Practice Address - Fax:800-889-3341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5006123363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty