Provider Demographics
NPI:1396889424
Name:FIELDS, LISA BUFFALOE (MSN, RN, CNS,)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:BUFFALOE
Last Name:FIELDS
Suffix:
Gender:F
Credentials:MSN, RN, CNS,
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:1618 US 1 HWY
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27596-9219
Mailing Address - Country:US
Mailing Address - Phone:919-562-9922
Mailing Address - Fax:919-562-9917
Practice Address - Street 1:1618 US 1 HWY
Practice Address - Street 2:
Practice Address - City:YOUNGSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27596-9219
Practice Address - Country:US
Practice Address - Phone:919-562-9922
Practice Address - Fax:919-562-9917
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC116174364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6004057Medicaid
NC6004057Medicaid
NC2604617BMedicare PIN