Provider Demographics
NPI:1063720712
Name:GRIDER, LUGENIA (CCE, CD, CPYI, HE II)
Entity type:Individual
Prefix:
First Name:LUGENIA
Middle Name:
Last Name:GRIDER
Suffix:
Gender:F
Credentials:CCE, CD, CPYI, HE II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9328 AMY DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-3765
Mailing Address - Country:US
Mailing Address - Phone:704-904-4433
Mailing Address - Fax:704-384-8013
Practice Address - Street 1:9328 AMY DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-3765
Practice Address - Country:US
Practice Address - Phone:704-904-4433
Practice Address - Fax:704-384-8013
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174H00000XOther Service ProvidersHealth Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC90-0143206OtherTAX ID