Individual
LISA L MIMS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
504 BURTON ST, FUQUAY VARINA, NC 27526-1608
(919) 753-8042
(919) 762-7621
Mailing address
504 BURTON ST, FUQUAY VARINA, NC 27526-1608
(919) 753-8042
(919) 762-7621
Taxonomy
Speciality
Code
Description
License number
State
311Z00000X
Custodial Care Facility
Primary
—
—
311ZA0620X
Adult Care Home Facility
—
—
Other
Enumeration date
08/09/2022
Last updated
08/09/2022
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