Provider Demographics
NPI:1548855919
Name:SEPIC, LUCILLE ROSE
Entity type:Individual
Prefix:
First Name:LUCILLE
Middle Name:ROSE
Last Name:SEPIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10900 WORLD TRADE BLVD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-4202
Mailing Address - Country:US
Mailing Address - Phone:197-484-9159
Mailing Address - Fax:866-538-4716
Practice Address - Street 1:7850 BRIER CREEK PKWY STE 102
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-8900
Practice Address - Country:US
Practice Address - Phone:919-748-4878
Practice Address - Fax:919-748-4876
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-07
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant