Provider Demographics
NPI:1629549647
Name:BLUE, LASHONE M
Entity Type:Individual
Prefix:
First Name:LASHONE
Middle Name:M
Last Name:BLUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 BERKELEY ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-3531
Mailing Address - Country:US
Mailing Address - Phone:919-810-5267
Mailing Address - Fax:
Practice Address - Street 1:3315 GUESS RD UNIT 9
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-6907
Practice Address - Country:US
Practice Address - Phone:919-286-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist