MEDICARE: DR. LISA REGINA PARK AUD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	7316	NC
2	237600000X	Audiologist-Hearing Aid Fitter	7316	NC

General Provider Information

NPI Number	:	1558414938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA REGINA PARK AUD

Provider Business Mailing Address
First Line	:	5221 PARAMOUNT PKWY STE 420
Second Line	:
City	:	MORRISVILLE
State	:	NC
Zip	:	27560-5491
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5501 FORTUNES RIDGE DR STE A
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27713-6102
Country	:	US
Telephone Number	:	919-419-1449
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	10/17/2024

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