Healthcare Provider Details

I. General information

NPI: 1548920309
Provider Name (Legal Business Name): RAHEL R LASSITER CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2021
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3808 CRANWELL CT
GREENSBORO NC
27407-7868
US

IV. Provider business mailing address

3808 CRANWELL CT
GREENSBORO NC
27407-7868
US

V. Phone/Fax

Practice location:
  • Phone: 336-404-4933
  • Fax:
Mailing address:
  • Phone: 336-404-4933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number0129000139
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: