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1699762039
GINA LICAUSE
CHARLOTTE, NC
NPI
1699762039
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
207Q00000X Family Medicine
(Licence: NC 35695)
Enumeration Date
2005-09-30
Last Update Date
2021-09-27
Business Address
GINA LICAUSE MD
101 E WT HARRIS BLVD STE 5002
CHARLOTTE, NC 28262-3485
Phone number: 704-801-7310
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Mailing Address
GINA LICAUSE MD
PO BOX 19305
CHARLOTTE, NC 28219-9305
Phone number:
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