Healthcare Provider Details

I. General information

NPI: 1225880735
Provider Name (Legal Business Name): MS. LAKENDRA MONETTE MAYO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2024
Last Update Date: 04/05/2024
Certification Date: 04/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 DANUBE LN APT 502
DURHAM NC
27704-1848
US

IV. Provider business mailing address

4801 DANUBE LN APT 502
DURHAM NC
27704-1848
US

V. Phone/Fax

Practice location:
  • Phone: 984-710-6189
  • Fax:
Mailing address:
  • Phone: 984-710-6189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: