Healthcare Provider Details

I. General information

NPI: 1760951255
Provider Name (Legal Business Name): LORRAINE ROCCO REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LORRAINE REILLY REGISTERED NURSE

II. Dates (important events)

Enumeration Date: 11/14/2018
Last Update Date: 11/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5317 HIGHGATE DR STE 115
DURHAM NC
27713-6622
US

IV. Provider business mailing address

211 S ENGLISH HILL LN
HILLSBOROUGH NC
27278-6510
US

V. Phone/Fax

Practice location:
  • Phone: 919-864-8361
  • Fax:
Mailing address:
  • Phone: 919-389-3080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number11168404
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: