Provider Demographics
NPI:1073707311
Name:BLEVINS, LISA PATRICE (APRN-BC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:PATRICE
Last Name:BLEVINS
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:PATRICE
Other - Last Name:HARRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:4705 UNIVERSITY DRIVE
Mailing Address - Street 2:BLDG
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707
Mailing Address - Country:US
Mailing Address - Phone:919-237-1337
Mailing Address - Fax:919-237-1625
Practice Address - Street 1:7850 BRIER CREEK PKWY STE 220
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-8900
Practice Address - Country:US
Practice Address - Phone:919-578-7008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5003510163W00000X, 363LF0000X
NC144763363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1073707311OtherINDIVIDUAL TAX INDENTIFICATION