Individual
LILIA A. REPNIKOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
(336) 716-0524
Mailing address
PO BOX 602658, CHARLOTTE, NC 28260-2658
(336) 716-2255
(336) 716-0524
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
0010-01034
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00685973
RR MEDICARE
NC
Enumeration date
09/19/2007
Last updated
05/18/2012
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