Provider Demographics
NPI:1962483297
Name:STARBUCK, ALISA LAWSON (RN NNP)
Entity Type:Individual
Prefix:MRS
First Name:ALISA
Middle Name:LAWSON
Last Name:STARBUCK
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Gender:F
Credentials:RN NNP
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Mailing Address - Street 1:1289 BLACK MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:PILOT MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:27041-7329
Mailing Address - Country:US
Mailing Address - Phone:336-713-6498
Mailing Address - Fax:336-713-2242
Practice Address - Street 1:MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-713-6498
Practice Address - Fax:336-713-2242
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2007-09-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC930079363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7003640Medicaid
NC2592129Medicare ID - Type Unspecified
NCQ22337Medicare UPIN