Provider Demographics
NPI:1205899234
Name:MICHEL, LISA VOLLANO (PA)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:VOLLANO
Last Name:MICHEL
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Gender:F
Credentials:PA
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Mailing Address - Street 1:3521 GRAYSTONE PL SE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CONOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28613-8201
Mailing Address - Country:US
Mailing Address - Phone:828-326-2354
Mailing Address - Fax:828-326-2385
Practice Address - Street 1:3521 GRAYSTONE PL SE
Practice Address - Street 2:SUITE 202
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-8201
Practice Address - Country:US
Practice Address - Phone:828-326-2354
Practice Address - Fax:828-326-2385
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2013-08-16
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Provider Licenses
StateLicense IDTaxonomies
NC103045363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP19329Medicare UPIN
NC2752992AMedicare PIN