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Individual

EILEEN LAZECKO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
2800 ASHTON DR, WILMINGTON, NC 28412-2575
(910) 794-8895
Mailing address
527 COMMONS WAY, WILMINGTON, NC 28409-9189
(815) 715-3733

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-05397
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1063801793
NC
Enumeration date
01/19/2015
Last updated
08/19/2020
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