Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 2002-01396 | NC |
NPI | 1710906524 |
---|---|
Provider Name | Dr. Lisa Maria Perino |
First Address | Flat Rock, NC 28731-9447 |
Second Address | Flat Rock, NC 28731-9447 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 22/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
136YK | BCBS (01) | NC |
89136YK | (05) | NC |
F70260 | (02) |