Provider Demographics
NPI:1639312333
Name:DISHMAN, LISA E (RRT, RCP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:E
Last Name:DISHMAN
Suffix:
Gender:F
Credentials:RRT, RCP
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:E
Other - Last Name:SUPTELA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RRT, RCP
Mailing Address - Street 1:700-B CROMWELL DRIVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5832
Mailing Address - Country:US
Mailing Address - Phone:252-830-2094
Mailing Address - Fax:252-355-7358
Practice Address - Street 1:700-B CROMWELL DRIVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5832
Practice Address - Country:US
Practice Address - Phone:252-830-2094
Practice Address - Fax:252-355-7358
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-09
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4731227900000X
NCA-4731227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7210754Medicaid