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NPI Code Detail

MEDICARE: LISA NEVAREZ

MEDICARE:   LISA  NEVAREZ
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
1225700000XMassage Therapist3228NC

General Provider Information

NPI Number : 1699434365
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA NEVAREZ
Provider Business Mailing Address
First Line : 1010 NUTT ST APT 3219
Second Line :
City : WILMINGTON
State : NC
Zip : 28401-5485
Country : US
Telephone Number : 910-228-9026
Fax Number :
Provider Business Practice Location Address
First Line : 3804 PARK AVE STE C
Second Line :
City : WILMINGTON
State : NC
Zip : 28403-6737
Country : US
Telephone Number : 910-228-9026
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/10/2021
Last Update Date : 12/10/2021

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Directions to “ LISA NEVAREZ ” Practice Location

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