Healthcare Provider Details

I. General information

NPI: 1780264846
Provider Name (Legal Business Name): LINDSAY WIECZOREK PHD, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 04/13/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 FAYETTEVILLE ST STE 201
RALEIGH NC
27601-3034
US

IV. Provider business mailing address

1 DRUMMOND CT
DURHAM NC
27713-8681
US

V. Phone/Fax

Practice location:
  • Phone: 314-322-8632
  • Fax:
Mailing address:
  • Phone: 314-322-8632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number296811
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: