Provider Demographics
NPI:1578334819
Name:BAIN, LISA DER (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:DER
Last Name:BAIN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-9389
Mailing Address - Country:US
Mailing Address - Phone:828-559-3399
Mailing Address - Fax:
Practice Address - Street 1:31 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-9389
Practice Address - Country:US
Practice Address - Phone:828-559-3399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-15
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17301472732081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine