Provider Demographics
NPI:1063775138
Name:LIDANOVA, IRINA (L AC, DIPL AC)
Entity type:Individual
Prefix:MS
First Name:IRINA
Middle Name:
Last Name:LIDANOVA
Suffix:
Gender:F
Credentials:L AC, DIPL AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 HANNA ST APT A
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-4308
Mailing Address - Country:US
Mailing Address - Phone:919-448-6539
Mailing Address - Fax:
Practice Address - Street 1:109 CONNER DR
Practice Address - Street 2:SUITE 103
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-7039
Practice Address - Country:US
Practice Address - Phone:919-933-4151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-22
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC649171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist