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Individual

LISA YONG KIMMERLE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CRNA

Contact information

Practice address
14215 BALLANTYNE CORPORATE PL STE 210, CHARLOTTE, NC 28277-3873
(704) 316-2650
Mailing address
616 WINTER WHEAT CT, WEDDINGTON, NC 28104-6136
(704) 774-9225

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
230428
NC
367500000X
Certified Registered Nurse Anesthetist
RN178243
GA

Other

Enumeration date
06/03/2006
Last updated
05/16/2022
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