Provider Demographics
NPI:1780284745
Name:LACORTE, JENEAN
Entity type:Individual
Prefix:MRS
First Name:JENEAN
Middle Name:
Last Name:LACORTE
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 1:18676 HWY 17 N.
Mailing Address - Street 2:SUITE 11
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443
Mailing Address - Country:US
Mailing Address - Phone:910-232-1117
Mailing Address - Fax:
Practice Address - Street 1:18676 HWY 17 N.
Practice Address - Street 2:SUITE 11
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443
Practice Address - Country:US
Practice Address - Phone:910-232-1117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZA2600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherArt, Medical