Provider Demographics
NPI:1134095797
Name:MASISAK, LISA M (RN BSN)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:M
Last Name:MASISAK
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 N CAPPS ST
Mailing Address - Street 2:
Mailing Address - City:PINE LEVEL
Mailing Address - State:NC
Mailing Address - Zip Code:27568-9059
Mailing Address - Country:US
Mailing Address - Phone:919-376-7787
Mailing Address - Fax:
Practice Address - Street 1:206 N CAPPS ST
Practice Address - Street 2:
Practice Address - City:PINE LEVEL
Practice Address - State:NC
Practice Address - Zip Code:27568-9059
Practice Address - Country:US
Practice Address - Phone:919-376-7787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-13
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC320438163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency