Provider Demographics
NPI:1497075659
Name:WILSON, LORENA ROCHA (MD)
Entity Type:Individual
Prefix:DR
First Name:LORENA
Middle Name:ROCHA
Last Name:WILSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LORENA
Other - Middle Name:ROCHA
Other - Last Name:PEREIRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:19 SANGRE DE CRISTO DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-2872
Mailing Address - Country:US
Mailing Address - Phone:770-653-3691
Mailing Address - Fax:
Practice Address - Street 1:19 SANGRE DE CRISTO DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-2872
Practice Address - Country:US
Practice Address - Phone:770-653-3691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-09
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2013-00679207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology