Provider Demographics
NPI:1881646842
Name:RUDISILL, LISA A (MSN FNP C)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:A
Last Name:RUDISILL
Suffix:
Gender:F
Credentials:MSN FNP C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1771 TATE BLVD SE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-4249
Mailing Address - Country:US
Mailing Address - Phone:828-322-1128
Mailing Address - Fax:828-327-9431
Practice Address - Street 1:1771 TATE BLVD SE
Practice Address - Street 2:SUITE 103
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-4249
Practice Address - Country:US
Practice Address - Phone:828-322-1128
Practice Address - Fax:828-327-9431
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC092475363LF0000X
NC201668363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P81350Medicare UPIN
NCNCD224AMedicare PIN