Provider Demographics
NPI:1275588758
Name:GOLDSTEIN, LISA (CNM)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 GRAVY HILL LN
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28714-7471
Mailing Address - Country:US
Mailing Address - Phone:828-678-9797
Mailing Address - Fax:828-678-9799
Practice Address - Street 1:451 WID SMITH RD
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28714-7644
Practice Address - Country:US
Practice Address - Phone:828-678-9797
Practice Address - Fax:828-678-9799
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC211367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC07673OtherBCBS PHYSICIAN
NC8907673OtherMEDICAID
NC014MXOtherBCBS LABS
0081POtherBCBS SWINGBED
NC235013OtherMEDICARE PHYSICIAN
NC235013BOtherMEDICARE PHYSICIAN
NC00513OtherBCBS
NC3400011OtherMEDICAID
NC36118OtherBCBS
NC34U011OtherMEDICARE SWINGBED
NC7000037Medicaid
NC235013OtherMEDICARE PHYSICIAN
NC8907673OtherMEDICAID