Individual
MRS. LISA MARIE SUDDRETH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, NP-C, PMHNP-BC
Contact information
Practice address
830 SUMMIT CROSSING PL, GASTONIA, NC 28054-2192
(704) 917-7610
(704) 917-7615
Mailing address
4089 BORDEAUX DR., DENVER, NC 28037
(980) 434-8236
(704) 917-7615
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
5004669
NC
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
5004669
NC
Other
Enumeration date
03/29/2010
Last updated
03/17/2018
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