Provider Demographics
NPI:1780880054
Name:NELSON, LISA CARRAWAY (MD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:CARRAWAY
Last Name:NELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 BROWN ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-4670
Mailing Address - Country:US
Mailing Address - Phone:252-948-1393
Mailing Address - Fax:252-948-1392
Practice Address - Street 1:1005 BROWN ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-4670
Practice Address - Country:US
Practice Address - Phone:252-948-1393
Practice Address - Fax:252-948-1392
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-00955207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC146HHOtherBLUE CROSS
NC5908673Medicaid
NC146HHOtherBLUE CROSS