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General NPI Number Information
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NPI Number | 1205177714
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Entity Type | Individual
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Provider Name | LISA VIRGINIA WHARTON PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/07/2013
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Last Update Date | 09/23/2014
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Provider Practice Location Address
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Address Line | 1412 CAROLINA AVE
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City | WASHINGTON
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State | NC
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Zip | 27889-3314
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Country | US
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Telephone | 252-623-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 104 PERQUIMANS DR
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City | CHOCOWINITY
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State | NC
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Zip | 27817-8886
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Country | US
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Telephone | 336-251-5646
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 0010-04063
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License Number State | NC
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