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Contact Information

LAKE NORMAN SURGICAL ASSISTING
1130 GRACE MEADOW DR
MOORESVILLE, NC28115-2789
 Phone: 704-663-4989
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Surgical

363AS0400X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for LAKE NORMAN SURGICAL ASSISTING · (Female)

NPI # 1093005878
Status Active
Credentials
Entity Individual
Enumeration date 04/13/2011
Last updated 04/01/2014 - About 12 years ago
Sole proprietor 1 Not specified
Identifiers
  • NC License # 101593
  • Other 2348238 MEDICARE GROUP PTAN
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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