Provider Demographics
NPI:1740751353
Name:ORSO, NICOLE (NP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:ORSO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 KEISLER DR STE 204
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-7083
Mailing Address - Country:US
Mailing Address - Phone:919-233-0059
Mailing Address - Fax:919-233-0343
Practice Address - Street 1:300 KEISLER DR STE 204
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7083
Practice Address - Country:US
Practice Address - Phone:919-233-0059
Practice Address - Fax:919-233-0343
Is Sole Proprietor?:No
Enumeration Date:2018-12-07
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5011273363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC363L00000XMedicaid