Healthcare Provider Details

I. General information

NPI: 1114258233
Provider Name (Legal Business Name): ANNA HAYDEN LEQUIRE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2010
Last Update Date: 01/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1927 THURMOND PL
CHARLOTTE NC
28205-3038
US

IV. Provider business mailing address

1927 THURMOND PL
CHARLOTTE NC
28205-3038
US

V. Phone/Fax

Practice location:
  • Phone: 704-840-8815
  • Fax:
Mailing address:
  • Phone: 704-840-8815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number214065
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: