Healthcare Provider Details

I. General information

NPI: 1437506375
Provider Name (Legal Business Name): JANET NIQUETTE LUCIEN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JANET NIQUETTE PFISTER

II. Dates (important events)

Enumeration Date: 05/20/2016
Last Update Date: 08/12/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 SUNNYBROOK RD
RALEIGH NC
27610-1855
US

IV. Provider business mailing address

PO BOX 603949
CHARLOTTE NC
28260-3949
US

V. Phone/Fax

Practice location:
  • Phone: 919-350-7584
  • Fax: 919-231-0314
Mailing address:
  • Phone: 919-350-0351
  • Fax: 919-350-7687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2019-01152
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number2019-01152
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: