Individual
LISA GAYLE MCIVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
105 HANES SQUARE CIR, WINSTON SALEM, NC 27103-5514
(336) 441-5569
(336) 771-1907
Mailing address
PO BOX 601843, CHARLOTTE, NC 28260-1843
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5018951
NC
363LF0000X
Family Nurse Practitioner
5018951
NC
363LF0000X
Family Nurse Practitioner
95009478
CA
Other
Enumeration date
07/16/2018
Last updated
11/12/2024
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