Individual
JANEICE LASTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6020 MEADOWDALE DR, WINSTON SALEM, NC 27105-9660
(336) 575-8836
Mailing address
6020 MEADOWDALE DR, WINSTON SALEM, NC 27105-9660
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
NH103
NC
Other
Enumeration date
12/03/2010
Last updated
12/03/2010
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