Provider Demographics
NPI:1689942732
Name:SUGGS, LAWANDA FAYE
Entity Type:Individual
Prefix:MISS
First Name:LAWANDA
Middle Name:FAYE
Last Name:SUGGS
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 1:2224 BRIARFIELD RD
Mailing Address - Street 2:2224 BRIARFIELD RD
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28501
Mailing Address - Country:US
Mailing Address - Phone:252-286-8951
Mailing Address - Fax:
Practice Address - Street 1:2224 BRIARFIELD RD
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-1702
Practice Address - Country:US
Practice Address - Phone:252-286-8951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-05
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1689942732Medicaid