1558533968 NPI number — DR. NICOLE LACOSTE CANTLEY PH.D.

Table of content: DR. NICOLE LACOSTE CANTLEY PH.D. (NPI 1558533968)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558533968 NPI number — DR. NICOLE LACOSTE CANTLEY PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CANTLEY
Provider First Name:
NICOLE
Provider Middle Name:
LACOSTE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LACOSTE
Provider Other First Name:
NICOLE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1558533968
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/23/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2101 SARDIS RD N
Provider Second Line Business Mailing Address:
SUITE 220
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28227
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-841-1163
Provider Business Mailing Address Fax Number:
704-841-1164

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2101 SARDIS RD N
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-841-1163
Provider Business Practice Location Address Fax Number:
704-841-1164
Provider Enumeration Date:
03/25/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  3520 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com