Provider Demographics
NPI:1437506375
Name:LUCIEN, JANET NIQUETTE (DO)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:NIQUETTE
Last Name:LUCIEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:NIQUETTE
Other - Last Name:PFISTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 603949
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-3949
Mailing Address - Country:US
Mailing Address - Phone:919-350-0351
Mailing Address - Fax:919-350-7687
Practice Address - Street 1:23 SUNNYBROOK RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1855
Practice Address - Country:US
Practice Address - Phone:919-350-7584
Practice Address - Fax:919-231-0314
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-20
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2019-01152208000000X, 2080P0205X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1437506375Medicaid