Provider Demographics
NPI:1386753457
Name:LAKE NORMAN ANESTHESIA ASSOCIATES
Entity type:Organization
Organization Name:LAKE NORMAN ANESTHESIA ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WOZNY
Authorized Official - Suffix:
Authorized Official - Credentials:CPC, CAPPM
Authorized Official - Phone:704-662-0876
Mailing Address - Street 1:146 MEDICAL PARK RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8528
Mailing Address - Country:US
Mailing Address - Phone:704-662-0877
Mailing Address - Fax:704-662-0875
Practice Address - Street 1:146 MEDICAL PARK RD
Practice Address - Street 2:SUITE 108
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8528
Practice Address - Country:US
Practice Address - Phone:704-662-0877
Practice Address - Fax:704-662-0875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890200HMedicaid
NC2314565Medicare UPIN