Individual
MRS. SARAH LEAGUE LYCAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
(336) 716-9016
Mailing address
PO BOX 602658, CHARLOTTE, NC 28260-2658
(336) 716-2255
(336) 716-9016
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
5005689
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7006173
—
NC
Enumeration date
12/17/2009
Last updated
10/05/2012
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