Provider Demographics
NPI:1902111446
Name:MCMAHON, ELIZABETH VERGARA (FNP-C)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:VERGARA
Last Name:MCMAHON
Suffix:
Gender:F
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 1:3100 DURALEIGH RD STE 205
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-8105
Mailing Address - Country:US
Mailing Address - Phone:919-784-7874
Mailing Address - Fax:919-784-2708
Practice Address - Street 1:3100 DURALEIGH RD STE 205
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8105
Practice Address - Country:US
Practice Address - Phone:919-784-7874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2010005721363LF0000X
NC0024168935363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1922008291Medicaid
VAVAA113262Medicare PIN