Individual
MS. LISA MICHELLE MATUGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LISA MATUGA, PA-C
Contact information
Practice address
14214 BALLANTYNE LAKE RD, SUITE 100, CHARLOTTE, NC 28277-3373
(704) 667-2650
(704) 544-0172
Mailing address
15830 BALLANTYNE MEDICAL PL, STE 100, CHARLOTTE, NC 28277-0762
(704) 667-2650
(704) 544-0172
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0010-02499
NC
363AM0700X
Medical Physician Assistant
5601005362
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8101140
—
NC
Enumeration date
09/29/2008
Last updated
02/07/2017
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