1346210937 NPI number — DR. LISA D NURRE MD

Table of content: DR. LISA D NURRE MD (NPI 1346210937)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346210937 NPI number — DR. LISA D NURRE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NURRE
Provider First Name:
LISA
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346210937
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 392
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SYLVA
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28779-0392
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-467-3381
Provider Business Mailing Address Fax Number:
828-586-8209

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 PEACHTREE RD STE 106
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28803-3180
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-232-5222
Provider Business Practice Location Address Fax Number:
828-258-3003
Provider Enumeration Date:
01/25/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  9501031 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 89128UG , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".