Healthcare Provider Details

I. General information

NPI: 1134095797
Provider Name (Legal Business Name): LISA M MASISAK RN BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2025
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 N CAPPS ST
PINE LEVEL NC
27568-9059
US

IV. Provider business mailing address

206 N CAPPS ST
PINE LEVEL NC
27568-9059
US

V. Phone/Fax

Practice location:
  • Phone: 919-376-7787
  • Fax:
Mailing address:
  • Phone: 919-376-7787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number320438
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: