Lavender, Sidney Wilson

Lavender, Sidney Wilson is an individual health care provider with primary practice located at Medical Center Blvd , Winston Salem NC 27157-0001. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Surgical, which is considered as his primary health care specialty. Lavender, Sidney Wilson can be contacted via phone (336) 716-2255.

Contact Information

Primary practice address
Medical Center Blvd Winston Salem NC 27157-0001
Phone: (336) 716-2255
Fax: (336) 716-3348
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X 000100189 North Carolina

Profile Details

NPI number 1609859313
LBN Legal business name Lavender, Sidney Wilson
Credentials PAC
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 28th, 2005
Last updated Aug 20th, 2010 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1609859313 NPPES
Other 7008754 AETNA
Other 94713 AETNA
Other 5554 AETNA

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