Provider Demographics
NPI:1073028932
Name:COLLINS, LISA (BSN, RN-BC, CLC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:BSN, RN-BC, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5349 NESSEE ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-8588
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5349 NESSEE ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-8588
Practice Address - Country:US
Practice Address - Phone:919-423-4169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-13
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC202608163WC0200X, 163WG0000X, 163WP0200X, 163WI0500X, 163WN0003X, 163WL0100X
251F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WN0003XNursing Service ProvidersRegistered NurseNeonatal, Low-Risk
No251F00000XAgenciesHome Infusion