Provider Demographics
NPI:1902832801
Name:HASAN, LISA BIRL (PA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:BIRL
Last Name:HASAN
Suffix:
Gender:F
Credentials:PA
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Other - First Name:
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Mailing Address - Street 1:8360 SIX FORKS RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-5077
Mailing Address - Country:US
Mailing Address - Phone:919-848-0132
Mailing Address - Fax:919-848-0277
Practice Address - Street 1:8360 SIX FORKS RD
Practice Address - Street 2:SUITE 202
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-5077
Practice Address - Country:US
Practice Address - Phone:919-848-0132
Practice Address - Fax:919-848-0277
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant