Healthcare Provider Details

I. General information

NPI: 1871986547
Provider Name (Legal Business Name): LILIYANA TEICHERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2015
Last Update Date: 03/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 HOSPITAL DR
MONROE NC
28112-6000
US

IV. Provider business mailing address

1004 TALBOT CT
INDIAN TRAIL NC
28079-3411
US

V. Phone/Fax

Practice location:
  • Phone: 980-993-3100
  • Fax:
Mailing address:
  • Phone: 315-542-3774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number211171
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: