Provider Demographics
NPI:1588618656
Name:LAMIELLE, CINDY OLDSON (PA-C)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:OLDSON
Last Name:LAMIELLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 416
Mailing Address - Street 2:
Mailing Address - City:BAYBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28515-0416
Mailing Address - Country:US
Mailing Address - Phone:252-745-2070
Mailing Address - Fax:252-745-2202
Practice Address - Street 1:313 MAIN ST
Practice Address - Street 2:
Practice Address - City:BAYBORO
Practice Address - State:NC
Practice Address - Zip Code:28515
Practice Address - Country:US
Practice Address - Phone:252-745-2070
Practice Address - Fax:252-745-2202
Is Sole Proprietor?:No
Enumeration Date:2006-05-21
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103278363A00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2750091Medicare PIN
NCP00071467Medicare PIN
NCP47149Medicare UPIN