Provider Demographics
NPI:1184912149
Name:HARDEE, LISA GAUSE (LPN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:GAUSE
Last Name:HARDEE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 W 29TH ST
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2901
Mailing Address - Country:US
Mailing Address - Phone:910-618-5606
Mailing Address - Fax:
Practice Address - Street 1:207 W 29TH ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2901
Practice Address - Country:US
Practice Address - Phone:910-618-5606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC065910164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse