Provider Demographics
NPI:1932514825
Name:MANTZOURIS, STEPHEN (FNP-C)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:MANTZOURIS
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 ELIZABETH ST
Mailing Address - Street 2:APARTMENT D8
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-3212
Mailing Address - Country:US
Mailing Address - Phone:910-964-5979
Mailing Address - Fax:
Practice Address - Street 1:220 ELIZABETH ST
Practice Address - Street 2:UNIT D8
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514
Practice Address - Country:US
Practice Address - Phone:910-964-5979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-30
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5006959363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner