Provider Demographics
NPI:1609275247
Name:TERRY, LISA CONNER (HIS, LIC#1424)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:CONNER
Last Name:TERRY
Suffix:
Gender:F
Credentials:HIS, LIC#1424
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 E DIXON BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28152-6848
Mailing Address - Country:US
Mailing Address - Phone:704-487-1128
Mailing Address - Fax:
Practice Address - Street 1:1506 E DIXON BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28152-6848
Practice Address - Country:US
Practice Address - Phone:704-487-1128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1424174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist