Individual
MICAELA ADDISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3992 LOVETTE RD, LUMBERTON, NC 28358-1807
(910) 736-1777
Mailing address
3992 LOVETTE RD, LUMBERTON, NC 28358-1807
(910) 736-1777
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
20259087
NC
Other
Enumeration date
03/02/2021
Last updated
03/02/2021
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