Provider Demographics
NPI:1770697559
Name:RASBACH, LISA ELLEN (APRN)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:ELLEN
Last Name:RASBACH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 SMITH LEVEL RD
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-3123
Mailing Address - Country:US
Mailing Address - Phone:843-696-6061
Mailing Address - Fax:
Practice Address - Street 1:3000 ERWIN ROAD SUITE 200
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710
Practice Address - Country:US
Practice Address - Phone:919-684-3772
Practice Address - Fax:919-684-8613
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDR208536363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics