Provider Demographics
NPI:1730456369
Name:GENOVESE, LISA MARIE (ARNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:GENOVESE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 DARRINGTON DR STE 101
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-8158
Mailing Address - Country:US
Mailing Address - Phone:198-523-9999
Mailing Address - Fax:919-378-9114
Practice Address - Street 1:804 ENGLISH RD STE 100
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-6027
Practice Address - Country:US
Practice Address - Phone:252-443-3133
Practice Address - Fax:252-443-0847
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9233666363LF0000X
NC320700363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily