Basic Information
| Provider Information | |||||||||
| NPI: | 1144365628 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROBINSON | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | APRN, CCRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1771 TATE BLVD SE STE 201 | ||||||||
| Address2: | |||||||||
| City: | HICKORY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286024250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283244804 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1771 TATE BLVD SE STE 201 | ||||||||
| Address2: | |||||||||
| City: | HICKORY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286024250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283244804 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2007 | ||||||||
| LastUpdateDate: | 01/12/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | 458367 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 363LA2100X | 293377 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
ID Information
| ID | Type | State | Issuer | Description | 1144365628 | 05 | NC | MEDICAID |