Healthcare Provider Details

I. General information

NPI: 1730456369
Provider Name (Legal Business Name): LISA MARIE GENOVESE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2011
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 ENGLISH RD STE 100
ROCKY MOUNT NC
27804-6027
US

IV. Provider business mailing address

1021 DARRINGTON DR STE 101
CARY NC
27513-8158
US

V. Phone/Fax

Practice location:
  • Phone: 252-443-3133
  • Fax: 252-443-0847
Mailing address:
  • Phone: 198-523-9999
  • Fax: 919-378-9114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9233666
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number320700
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number320700
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: