Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 5008055 | NC |
N | 363LA2100X | Nurse Practitioner - Acute Care | 5008055 | NC |
NPI | 1013387018 |
---|---|
Provider Name | Mrs. Lauren Amanda Leggett |
First Address | Charlotte, NC 28260-0447 |
Second Address | Charlotte, NC 28207 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2015 |
Last Update Date | 26/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013387018 | (05) | NC |
NCR092A | (02) | NC |
NP3580 | (05) | SC |