Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251H1200X | Hand | 5366 | NC |
NPI | 1689658916 |
---|---|
Provider Name | Mrs. Regina Mae Lefauve |
First Address | Mooresville, NC 28117-9225 |
Second Address | Mooresville, NC 28117-9225 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2005 |
Last Update Date | 27/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1372T | BCBS (01) | |
2414673 | UNITED HEALTHCARE (01) | |
7379530 | AETNA (01) | |
D8766 | MEDCOST (01) |