Provider Demographics
NPI:1467418673
Name:VENDELAND, LISA LYNN (D O)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:LYNN
Last Name:VENDELAND
Suffix:
Gender:F
Credentials:D O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2904 MILLS LAKE WYND
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-9741
Mailing Address - Country:US
Mailing Address - Phone:727-992-0707
Mailing Address - Fax:
Practice Address - Street 1:115 PARKWAY OFFICE CT STE 104
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7436
Practice Address - Country:US
Practice Address - Phone:919-851-3480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2015-00767207V00000X
FLOS8107207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00030730OtherRAILROAD MEDICARE
FL260021800Medicaid
FLE4296YMedicare ID - Type Unspecified
FL260021800Medicaid