MEDICARE: PORCIA MICHELLE LASTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse

General Provider Information

NPI Number	:	1649101429
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PORCIA MICHELLE LASTER LLC

Provider Business Mailing Address
First Line	:	1457 KELLY RD
Second Line	:
City	:	APEX
State	:	NC
Zip	:	27502-9572
Country	:	US
Telephone Number	:	984-222-4924
Fax Number	:

Provider Business Practice Location Address
First Line	:	2030 STRICKLAND OAK WAY
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27703
Country	:	US
Telephone Number	:	984-222-4924
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MISS PORCIA MICHELLE LASTER
Credential	:	RN
Telephone Number	:	984-222-4924

Provider Enumeration Date	:	05/28/2026
Last Update Date	:	06/16/2026

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