Healthcare Provider Details

I. General information

NPI: 1023299534
Provider Name (Legal Business Name): LORA LIN MOYLE LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2007
Last Update Date: 11/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 GRAHAM STREET SUITE A
MEBANE NC
27302
US

IV. Provider business mailing address

301 GRAHAM STREET SUITE A
MEBANE NC
27302
US

V. Phone/Fax

Practice location:
  • Phone: 919-563-5333
  • Fax:
Mailing address:
  • Phone: 919-563-5333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number405
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: