Provider Demographics
NPI:1255569109
Name:GOBROGGE, DIANE MARIE (LAC)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:MARIE
Last Name:GOBROGGE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 NORTH KERR
Mailing Address - Street 2:SUITE D-6
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405
Mailing Address - Country:US
Mailing Address - Phone:910-350-2740
Mailing Address - Fax:910-350-8964
Practice Address - Street 1:108 NORTH KERR
Practice Address - Street 2:SUITE D-6
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405
Practice Address - Country:US
Practice Address - Phone:910-350-2740
Practice Address - Fax:910-350-8964
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist