Provider Demographics
NPI:1295109569
Name:ELLIOTT, LISA (ARDMS)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:ARDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1183 MICAHS WAY N
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NC
Mailing Address - Zip Code:28390-2857
Mailing Address - Country:US
Mailing Address - Phone:406-223-3796
Mailing Address - Fax:
Practice Address - Street 1:1183 MICAHS WAY N
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:NC
Practice Address - Zip Code:28390-2857
Practice Address - Country:US
Practice Address - Phone:406-223-3796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-23
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography