Individual
LISA L MATHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN, IBCLC, RLC
Contact information
Practice address
12515 CEDAR FALL DRIVE, HUNTERSVILLE, NC 28078
(980) 213-5867
Mailing address
12525 CEDAR FALL DR, HUNTERSVILLE, NC 28078
(980) 213-5867
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
049048
NC
174400000X
Specialist
Primary
101-117460
NC
Other
Enumeration date
01/25/2011
Last updated
01/25/2011
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