Individual provider Active NPI

Eileen C Finnegan, CRNP

  • Nurse Practitioner
  • Charlotte, NC
National Provider Identifier
1063674034
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
5008990 Issued in NC
Practice address
10130 Perimeter Pkwy Ste 200
Charlotte, NC 28216-0197
Phone
(888) 849-7379
Fax
(855) 857-7333
NPI assigned
Jun 30, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 26NN08411600 NJ
Nurse Practitioner 363L00000X 5008990 NC Primary

Addresses

Primary practice location

10130 Perimeter Pkwy Ste 200
Charlotte, NC 28216-0197

Mailing address

10130 Perimeter Pkwy Ste 200
Charlotte, NC 28216-0197
Phone (888) 849-7379

Other identifiers 1

IdentifierTypeStateIssuer
7600305MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170607001743 NC Practitioner - Nurse Practitioner 6305853458

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
5008990NCMDNurse Practitioner
26NN08411600NJMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Lifesource of North Carolina Nurse Practitioner CurrentSince Aug 1, 2023 Accepting new patients
Lifesource of North Carolina Nurse Practitioner CurrentSince Aug 1, 2023 Accepting new patients
Atlantic Professional Services of New Jersey, P.a. Nurse Practitioner Past Accepting new patients

Locations

3205 Randall Pkwy
Ste 105
Wilmington, NC 28403
Phone (910) 338-2880

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1214784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1063674034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10130 PERIMETER PKWY STE 200",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282160197",
            "telephone_number": "888-849-7379",
            "fax_number": "855-857-7333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10130 PERIMETER PKWY STE 200",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282160197",
            "telephone_number": "888-849-7379",
            "fax_number": "855-857-7333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FINNEGAN",
        "first_name": "EILEEN",
        "middle_name": "C",
        "name_prefix": "Ms.",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-30",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NJ",
            "license": "26NN08411600",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5008990",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7600305",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.