Provider Demographics
NPI:1609854728
Name:VINZANI, CATHERINE O'FALLON (MSN, FNP)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:O'FALLON
Last Name:VINZANI
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:CATHERINE
Other - Last Name:VINZANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSN, FNP
Mailing Address - Street 1:5904 BAIRD DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-9444
Mailing Address - Country:US
Mailing Address - Phone:919-834-5205
Mailing Address - Fax:
Practice Address - Street 1:2815 CATES AVE
Practice Address - Street 2:BOX 7304
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27695-7304
Practice Address - Country:US
Practice Address - Phone:919-513-2536
Practice Address - Fax:188-897-2415
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201634363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2807566CMedicare UPIN
NC84098Medicare UPIN