| Lifesource Of North Carolina | |
|
1525 Eber Rd Holland OH 43528-9616 | |
| (910) 742-9243 | |
| Not Available |
| Full Name | Lifesource Of North Carolina |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 1525 Eber Rd, Holland, Ohio |
| Authorized Official Name and Position | Amanda Seymour (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 9107944521 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifesource Of North Carolina Po Box 538622 Atlanta GA 30353-8622 Ph: (910) 742-9243 | Lifesource Of North Carolina 1525 Eber Rd Holland OH 43528-9616 Ph: (910) 742-9243 |
| NPI Number | 1710620117 |
|---|---|
| Provider Enumeration Date | 04/14/2022 |
| Last Update Date | 04/10/2024 |
| Certification Date | 04/10/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710620117 | NPI | - | NPPES |
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