Individual provider Active NPI

Bozena Stasiak Narula, NP

  • Family Nurse Practitioner
  • Raleigh, NC
National Provider Identifier
1649687989
Registry record updated Dec 8, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
F0614355 Issued in NC
Practice address
3633 Harden Rd Ste 100
Raleigh, NC 27607-3369
Phone
(919) 784-3402
Fax
(919) 784-6232
NPI assigned
Jul 18, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X F0614355 NC Primary

Addresses

Primary practice location

3633 Harden Rd Ste 100
Raleigh, NC 27607-3369

Mailing address

110 Preston Executive Dr
Ste 100
Cary, NC 27513-8447
Phone (919) 852-3999

Other names 1

  • Bozena Elwira Stasiak Former name

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
I20141205000563 NC Practitioner - Nurse Practitioner 2163744947 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
F0614355NCMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Carolinas Physicians Network Inc Current Accepting new patients
Carolinas Physicians Network, Inc CurrentSince Jun 7, 2021 Accepting new patients
Carolinas Physicians Network Inc CurrentSince Jun 7, 2021 Accepting new patients

Locations

10620 Park Rd
Ste 202
Charlotte, NC 28210
Phone (704) 512-3988

14214 Ballantyne Lake Rd
Ste 100
Charlotte, NC 28277
Phone (704) 667-2650

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": "1405641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481155200000",
    "number": "1649687989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 PRESTON EXECUTIVE DR",
            "address_2": "STE 100",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275138447",
            "telephone_number": "919-852-3999",
            "fax_number": "919-378-9114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3633 HARDEN RD STE 100",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276073369",
            "telephone_number": "919-784-3402",
            "fax_number": "919-784-6232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NARULA",
        "first_name": "BOZENA",
        "middle_name": "STASIAK",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-18",
        "last_updated": "2016-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "F0614355",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BOZENA",
            "last_name": "STASIAK",
            "middle_name": "ELWIRA",
            "credential": "NP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Raleigh, NC

Sources for this page

Verify at the official NPI Registry.