Doctor Name: | MRS. MEAGAN BOLES LABERGE |
NPI Number: | 1316288228 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | P.A.-C |
License Number: | 0010-04104 |
Business Practice Address: | 108 Derby Dr King, NC - 270217974 |
Business Phone Number: | 3367103323 |
Business Fax Number: | |
Mailing Address: | 108 Derby Dr, KING |
State: | NC |
Postal Code: | 270217974 |
Phone Number: | 3367103323 |
Fax Number: | |
NPI Enumeration Date: | 03/04/2013 |
NPI Last Update Date: | 05/16/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 0010-04104 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |