Healthcare Provider Details

I. General information

NPI: 1083904361
Provider Name (Legal Business Name): MS. NANCY LELLE-MICHEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2011
Last Update Date: 04/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 TRENT DR DUKE CLINIC 2F/2G
DURHAM NC
27710-0001
US

IV. Provider business mailing address

5213 S ALSTON AVE
DURHAM NC
27713-4430
US

V. Phone/Fax

Practice location:
  • Phone: 919-684-8111
  • Fax: 919-668-1650
Mailing address:
  • Phone: 919-620-4917
  • Fax: 919-620-4921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number197453
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: