Individual
LISA CORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
4525 CAMERON VALLEY PKWY, STE 1500, CHARLOTTE, NC 28211-3546
(704) 512-6240
(704) 512-6241
Mailing address
PO BOX 601692, CHARLOTTE, NC 28260-1692
(704) 512-6240
(704) 512-6241
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
200907
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7004146
—
NC
Enumeration date
08/01/2006
Last updated
02/08/2012
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