Healthcare Provider Details

I. General information

NPI: 1447171566
Provider Name (Legal Business Name): LISA DEAN CPPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6955 SUMMERFIELD RD TRLR 26
SUMMERFIELD NC
27358-9262
US

IV. Provider business mailing address

6955 SUMMERFIELD RD TRLR 26
SUMMERFIELD NC
27358-9262
US

V. Phone/Fax

Practice location:
  • Phone: 336-962-1025
  • Fax:
Mailing address:
  • Phone: 336-962-1025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number2026-17192-01
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: