Provider Demographics
NPI:1528007259
Name:LALAMA, DEANNA MICHELLE GIDEONS (PA-C)
Entity type:Individual
Prefix:MS
First Name:DEANNA MICHELLE
Middle Name:GIDEONS
Last Name:LALAMA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2835 HORSE PEN CREEK RD STE 101
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-9700
Mailing Address - Country:US
Mailing Address - Phone:336-617-6568
Mailing Address - Fax:336-617-6660
Practice Address - Street 1:2835 HORSE PEN CREEK RD STE 101
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410
Practice Address - Country:US
Practice Address - Phone:336-617-6568
Practice Address - Fax:336-617-6660
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1066734363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC561274347OtherCKA'S TAX ID #
NC561274347OtherCKA'S TAX ID #
NC2763567Medicare ID - Type UnspecifiedMEDICARE PROVIDER #