Provider Demographics
NPI:1972007276
Name:EHRLICH, LISA SUSAN (NP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:SUSAN
Last Name:EHRLICH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14215 BALLANTYNE CORPORATE PL STE 240
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-3875
Practice Address - Country:US
Practice Address - Phone:704-316-7760
Practice Address - Fax:704-316-7761
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5010317363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5010317OtherNORTH CAROLINA BOARD OF NURSING