Provider Information for 1225614522
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LAKIA SHAKICE BRANCH
Sex: Female
NPI: 1225614522
Last Updated: 2021-03-31
Certification Date: 2021-03-31
Certification Date: 2021-03-31
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1225614522 | ||||||||
| Enumeration Date | 2021-03-18 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1928 RAY ALEXANDER DR GREENSBORO, NC 27410-1826 United States Phone: | Fax: | ||||||||
| Primary Practice Address | 236 N MEBANE ST STE 125 BURLINGTON, NC 27217-3957 United States Phone: 919-214-0862 | Fax:833-847-4855 | ||||||||
| Secondary Practice Address(es) | 236 N MEBANE ST STE 125 | ||||||||
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