Provider Demographics
NPI:1508929936
Name:FERRIGNO, LISA MARIE (PAC)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:MARIE
Last Name:FERRIGNO
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 TALLULAH RD
Mailing Address - Street 2:
Mailing Address - City:ROBBINSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28771-8500
Mailing Address - Country:US
Mailing Address - Phone:828-479-6434
Mailing Address - Fax:828-479-2917
Practice Address - Street 1:409 TALLULAH RD
Practice Address - Street 2:
Practice Address - City:ROBBINSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28771-8500
Practice Address - Country:US
Practice Address - Phone:828-479-6434
Practice Address - Fax:828-479-2917
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000879363A00000X
NC103619363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2770222Medicare Oscar/Certification