Individual
KAVITA SURA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
40 AUTUMN FERN TRL, LILLINGTON, NC 27546-5155
(919) 995-1436
Mailing address
40 AUTUMN FERN TRL, LILLINGTON, NC 27546-5155
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-06879
NC
Other
Enumeration date
01/08/2017
Last updated
01/28/2017
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