Provider Demographics
NPI:1780264846
Name:WIECZOREK, LINDSAY (PHD, RN)
Entity type:Individual
Prefix:DR
First Name:LINDSAY
Middle Name:
Last Name:WIECZOREK
Suffix:
Gender:F
Credentials:PHD, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DRUMMOND CT
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-8681
Mailing Address - Country:US
Mailing Address - Phone:314-322-8632
Mailing Address - Fax:
Practice Address - Street 1:555 FAYETTEVILLE ST STE 201
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27601-3034
Practice Address - Country:US
Practice Address - Phone:314-322-8632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC296811163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health