Healthcare Provider Details

I. General information

NPI: 1124094537
Provider Name (Legal Business Name): LISA HAREWOOD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 SPRINGFIELD COMMONS DR
RALEIGH NC
27609-8532
US

IV. Provider business mailing address

800 SPRINGFIELD COMMONS DR
RALEIGH NC
27609-8532
US

V. Phone/Fax

Practice location:
  • Phone: 919-876-3656
  • Fax: 919-876-2351
Mailing address:
  • Phone: 919-876-3656
  • Fax: 919-876-2351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number103087
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: