Provider Demographics
NPI:1922781830
Name:HAIRSTON, RHONDA LAFAYE
Entity Type:Individual
Prefix:MISS
First Name:RHONDA
Middle Name:LAFAYE
Last Name:HAIRSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:RHONDA
Other - Middle Name:LAFAYE
Other - Last Name:HAIRSTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5540 CENTERVIEW DR STE 204
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-8012
Mailing Address - Country:US
Mailing Address - Phone:336-558-4345
Mailing Address - Fax:
Practice Address - Street 1:1 WINTERTON CT
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-1153
Practice Address - Country:US
Practice Address - Phone:336-558-4345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier