Provider Demographics
NPI:1467910877
Name:LELLOCK, MARGARET ELIZABETH (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:ELIZABETH
Last Name:LELLOCK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:ELIZABETH
Other - Last Name:PEVARNIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4600 OLEANDER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-5149
Mailing Address - Country:US
Mailing Address - Phone:910-392-9502
Mailing Address - Fax:
Practice Address - Street 1:4600 OLEANDER DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-5149
Practice Address - Country:US
Practice Address - Phone:910-392-9502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-05
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5013684363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily