Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 158904 | NC |
NPI | 1033391248 |
---|---|
Provider Name | Lara A Reller |
First Address | Chapel Hill, NC 27516-2539 |
Second Address | Chapel Hill, NC 27599-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2007 |
Last Update Date | 29/11/2007 |