Healthcare Provider Details

I. General information

NPI: 1023231750
Provider Name (Legal Business Name): MS. ANNETTE GAUTHIER LEPORIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. ANNETTE GAUTHIER OBI

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 08/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 DUPONT CIR APT # 42
DURHAM NC
27705-2937
US

IV. Provider business mailing address

500 DUPONT CIR APT # 42
DURHAM NC
27705-2937
US

V. Phone/Fax

Practice location:
  • Phone: 704-308-8292
  • Fax:
Mailing address:
  • Phone: 704-308-8292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: