Healthcare Provider Details

I. General information

NPI: 1104739416
Provider Name (Legal Business Name): NORMA E VIDES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2026
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8301 SUMMERGLEN CIR
CHARLOTTE NC
28227-0370
US

IV. Provider business mailing address

8301 SUMMERGLEN CIR
CHARLOTTE NC
28227-0370
US

V. Phone/Fax

Practice location:
  • Phone: 240-464-5235
  • Fax:
Mailing address:
  • Phone: 240-464-5235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: