Provider Demographics
NPI:1033531421
Name:MULL, LISA L (FNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:L
Last Name:MULL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 S STERLING ST STE 300
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-4092
Mailing Address - Country:US
Mailing Address - Phone:828-580-4010
Mailing Address - Fax:828-580-4009
Practice Address - Street 1:2209 S STERLING ST STE 300
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-4092
Practice Address - Country:US
Practice Address - Phone:828-580-4010
Practice Address - Fax:828-580-4009
Is Sole Proprietor?:No
Enumeration Date:2014-01-20
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5006695363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1033531421Medicaid
NC5006695OtherNURSING LICENSE-FNP