Individual provider · Type 1 NPI

Alicia Lynne Ibanez, P.A.

Medical Physician Assistant · Charlotte, NC

NPI number 1124364070 Active

Practice location

2131 Ayrsley Town Blvd, Suite 400
Charlotte, NC 28273-3595

Call (980) 297-7733 Map

Fax (980) 297-7744

Mailing address

120 Chandeleur Dr
Mooresville, NC 28117-5954

Specialties and licenses

TaxonomyCodeLicense
Medical Physician Assistant Primary 363AM0700X0010-03995 (NC)

Medical Physician Assistant: Definition to come...

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About NPI 1124364070

Alicia Lynne Ibanez, P.A.'s National Provider Identifier is 1124364070, issued on Dec 21, 2012. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Charlotte, NC. The record was last updated on Jul 20, 2015.