Provider Demographics
NPI:1629767249
Name:BRACEY, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BRACEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 RED FIELD LN
Mailing Address - Street 2:
Mailing Address - City:TIMBERLAKE
Mailing Address - State:NC
Mailing Address - Zip Code:27583-7396
Mailing Address - Country:US
Mailing Address - Phone:919-321-8351
Mailing Address - Fax:
Practice Address - Street 1:72 RED FIELD LN
Practice Address - Street 2:
Practice Address - City:TIMBERLAKE
Practice Address - State:NC
Practice Address - Zip Code:27583-7396
Practice Address - Country:US
Practice Address - Phone:919-321-8351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care