Provider Demographics
NPI:1689731788
Name:LORDEUS, TAJUANA D (PA)
Entity Type:Individual
Prefix:MRS
First Name:TAJUANA
Middle Name:D
Last Name:LORDEUS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:TAJUANA
Other - Middle Name:D
Other - Last Name:CROSBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:NC
Mailing Address - Zip Code:27504-1177
Mailing Address - Country:US
Mailing Address - Phone:919-894-1740
Mailing Address - Fax:919-359-8689
Practice Address - Street 1:2645 MERIDIAN PKWY STE 323
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-4232
Practice Address - Country:US
Practice Address - Phone:984-227-8902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103614363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC204875OtherMEDCOST, DOCTOR'S DIRECT
NCMC0901593OtherDEA
NCNCA192EMedicare PIN
NCMC0901593OtherDEA
NCNCA192FMedicare PIN