MEDICARE: MISS RHONDA LAFAYE HAIRSTON

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	335E00000X	Prosthetic/Orthotic Supplier		NC

General Provider Information

NPI Number	:	1922781830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS RHONDA LAFAYE HAIRSTON

Provider Business Mailing Address
First Line	:	5540 CENTERVIEW DR STE 204
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27606-8012
Country	:	US
Telephone Number	:	336-558-4345
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 WINTERTON CT
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27455-1153
Country	:	US
Telephone Number	:	336-558-4345
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2023
Last Update Date	:	10/08/2024

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Directions to “ MISS RHONDA LAFAYE HAIRSTON ” Practice Location

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