Provider Demographics
NPI:1033472139
Name:CONDE-ZUEGE, RENATA (FNP)
Entity type:Individual
Prefix:
First Name:RENATA
Middle Name:
Last Name:CONDE-ZUEGE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 SLATER WAY
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-9453
Mailing Address - Country:US
Mailing Address - Phone:910-409-6528
Mailing Address - Fax:910-763-0291
Practice Address - Street 1:1414 PHYSICIANS DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7335
Practice Address - Country:US
Practice Address - Phone:910-409-6528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-22
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5006621363LF0000X
NY337311363LF0000X
NC223909363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1033472139Medicaid
SCQNP261Medicaid
NC1033472139Medicaid