Provider Demographics
NPI:1033829742
Name:SEMIDEY, EVELYN CHAMPAYNE (LMBT)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:CHAMPAYNE
Last Name:SEMIDEY
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 CAMERON CT
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7906
Mailing Address - Country:US
Mailing Address - Phone:910-409-7146
Mailing Address - Fax:
Practice Address - Street 1:1411 CAMERON CT
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7906
Practice Address - Country:US
Practice Address - Phone:910-409-7146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15492225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist