Provider Demographics
NPI:1861554701
Name:HUSTON, ELIZABETH LUM (NP)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:LUM
Last Name:HUSTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:W
Other - Last Name:HUSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:547 CRESTLINE BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-6860
Mailing Address - Country:US
Mailing Address - Phone:252-531-4302
Mailing Address - Fax:
Practice Address - Street 1:2602 COURTIER DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7818
Practice Address - Country:US
Practice Address - Phone:252-752-0483
Practice Address - Fax:252-757-3172
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2024-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5005415363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7006273Medicaid
NC561066387OtherBCBS