Individual
LISA ANNE PETRI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
207 MEDICAL ST, PILOT MOUNTAIN, NC 27041-8656
(336) 368-5011
(336) 368-1424
Mailing address
PO BOX 751803, CHARLOTTE, NC 28275-1803
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01562
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2004-01562
—
NC
Enumeration date
08/23/2005
Last updated
10/25/2020
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