MEDICARE: MS. LISA ELLEN RASBACH APRN

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	363LP0200X	Pediatric Nurse Practitioner	R208536	MD

General Provider Information

NPI Number	:	1770697559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LISA ELLEN RASBACH APRN

Provider Business Mailing Address
First Line	:	1430 SMITH LEVEL RD
Second Line	:
City	:	CHAPEL HILL
State	:	NC
Zip	:	27516-3123
Country	:	US
Telephone Number	:	843-696-6061
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 ERWIN ROAD SUITE 200
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27710
Country	:	US
Telephone Number	:	919-684-3772
Fax Number	:	919-684-8613

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

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	05/29/2018

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