Individual
ADOLLY FUABANA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
528 IMPALA TRCE, WENDELL, NC 27591-4447
(919) 641-6584
Mailing address
528 IMPALA TRCE, WENDELL, NC 27591-4447
(919) 641-6584
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
2025008446
NC
363LF0000X
Family Nurse Practitioner
Primary
5022499
NC
Other
Enumeration date
05/22/2025
Last updated
07/01/2025
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