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General NPI Number Information
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NPI Number | 1578517611
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Entity Type | Organization
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Legal Business Name | ALLERGY & ASTHMA CENTER OF LAKE NORMAN, PC
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Dates
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Enumeration Date | 05/22/2006
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Last Update Date | 12/16/2014
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Provider Practice Location Address
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Address Line | 15815 BROOKWAY DR
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-3221
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Country | US
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Telephone | 704-655-1466
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Fax | 704-655-1467
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Provider Business Mailing Address
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Address Line | 15815 BROOKWAY DR
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-3221
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Country | US
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Telephone | 704-655-1466
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Fax | 704-655-1467
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHRISTINA J. COLLURA
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Credential | D.O.
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Telephone | 704-655-1466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number |
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License Number State |
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