Provider Demographics
NPI:1275227670
Name:GBETE, JEANNE LYLIANE
Entity Type:Individual
Prefix:
First Name:JEANNE LYLIANE
Middle Name:
Last Name:GBETE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6008 RIVER LANDINGS DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-6136
Mailing Address - Country:US
Mailing Address - Phone:919-637-7384
Mailing Address - Fax:
Practice Address - Street 1:1109A CROSS LINK RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-4842
Practice Address - Country:US
Practice Address - Phone:919-637-7384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier