Provider Demographics
NPI: | 1154532273 |
---|---|
Name: | MILLER, LISA CHASE (RN) |
Entity type: | Individual |
Prefix: | |
First Name: | LISA |
Middle Name: | CHASE |
Last Name: | MILLER |
Suffix: | |
Gender: | F |
Credentials: | RN |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 979 CHASE DR |
Mailing Address - Street 2: | |
Mailing Address - City: | KINSTON |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 28504-9717 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 252-527-8603 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 227 KINGOLD BLVD STE B |
Practice Address - Street 2: | |
Practice Address - City: | SNOW HILL |
Practice Address - State: | NC |
Practice Address - Zip Code: | 28580-1303 |
Practice Address - Country: | US |
Practice Address - Phone: | 252-747-8181 |
Practice Address - Fax: | 252-747-8946 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2007-05-24 |
Last Update Date: | 2025-09-11 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NC | 082348 | 163W00000X, 163WC1500X, 163WW0101X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 163WW0101X | Nursing Service Providers | Registered Nurse | Women's Health Care, Ambulatory |
No | 163W00000X | Nursing Service Providers | Registered Nurse | |
No | 163WC1500X | Nursing Service Providers | Registered Nurse | Community Health |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NC | 082348 | Other | RN LICENSE # |