Healthcare Provider Details

I. General information

NPI: 1275227670
Provider Name (Legal Business Name): JEANNE LYLIANE GBETE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2023
Last Update Date: 06/07/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109A CROSS LINK RD
RALEIGH NC
27610-4842
US

IV. Provider business mailing address

6008 RIVER LANDINGS DR
RALEIGH NC
27604-6136
US

V. Phone/Fax

Practice location:
  • Phone: 919-637-7384
  • Fax:
Mailing address:
  • Phone: 919-637-7384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: