Individual
LISA PATRICE BLEVINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN-BC
Contact information
Practice address
7850 BRIER CREEK PKWY STE 220, RALEIGH, NC 27617-8900
(919) 578-7008
Mailing address
4705 UNIVERSITY DRIVE, BLDG, DURHAM, NC 27707
(919) 237-1337
(919) 237-1625
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
5003510
NC
363L00000X
Nurse Practitioner
144763
NC
363LF0000X
Family Nurse Practitioner
Primary
5003510
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1073707311
INDIVIDUAL TAX INDENTIFICATION
NC
Enumeration date
08/29/2007
Last updated
07/14/2023
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