Healthcare Provider Details

I. General information

NPI: 1356927552
Provider Name (Legal Business Name): LAUREN WINNIX RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2021
Last Update Date: 03/20/2021
Certification Date: 03/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 N TRYON ST STE 1600
CHARLOTTE NC
28202-0213
US

IV. Provider business mailing address

6020 TURTLE TRL UNIT 1206
CHARLOTTE NC
28262-1997
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax:
Mailing address:
  • Phone: 336-266-8593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberRBT-19-96172
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: