Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 900434 | NC |
Y | 363LW0102X | Nurse Practitioner - Women's Health | 184436 | NC |
NPI | 1093817389 |
---|---|
Provider Name | Ms. Lisa Inell Largent |
First Address | Gastonia, NC 28052-6430 |
Second Address | Gastonia, NC 28052-6430 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2006 |
Last Update Date | 03/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
184436 | RN NUMBER (01) | NC |
900434 | MEDICAL BOARD NUMBER (01) | NC |