Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 182872 | NC |
NPI | 1013126135 |
---|---|
Provider Name | Lesley Lauren Loder |
First Address | Charlotte, NC 28289-0041 |
Second Address | Hickory, NC 28602-9617 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 29/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
182872 | NC-RN LICENSE (01) | NC |
7004482 | (05) | NC |
8052895 | (05) | NC |