Doctor Name: | MRS. DIANNE TREACY LORE |
NPI Number: | 1538358619 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP-BC,PNP-BC |
License Number: | 162992 |
Business Practice Address: | 2469 Wendell Blvd Wendell, NC - 275916903 |
Business Phone Number: | 9193659045 |
Business Fax Number: | 9193659046 |
Mailing Address: | 2469 Wendell Blvd, WENDELL |
State: | NC |
Postal Code: | 27591 |
Phone Number: | 9193659045 |
Fax Number: | 9193659046 |
NPI Enumeration Date: | 10/15/2007 |
NPI Last Update Date: | 02/25/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 162992 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NC |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |