Provider Demographics
NPI:1417160292
Name:LANIER, LINDA (NP)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:
Last Name:LANIER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 S WALKER ST
Mailing Address - Street 2:
Mailing Address - City:BURGAW
Mailing Address - State:NC
Mailing Address - Zip Code:28425-5001
Mailing Address - Country:US
Mailing Address - Phone:910-259-1230
Mailing Address - Fax:910-259-1258
Practice Address - Street 1:803 S WALKER ST
Practice Address - Street 2:
Practice Address - City:BURGAW
Practice Address - State:NC
Practice Address - Zip Code:28425-5001
Practice Address - Country:US
Practice Address - Phone:910-259-1230
Practice Address - Fax:910-259-1258
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC800144363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7004015Medicaid