| Doctor Name: | LISA LAFATA |
| NPI Number: | 1639586704 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 5007011 |
| Business Practice Address: | 325 Nc Highway 55 W Mount Olive, NC - 283658527 |
| Business Phone Number: | 9196585900 |
| Business Fax Number: | 9102678981 |
| Mailing Address: | 325 Nc Highway 55 W, MOUNT OLIVE |
| State: | NC |
| Postal Code: | 283658527 |
| Phone Number: | 9196585900 |
| Fax Number: | 9102678981 |
| NPI Enumeration Date: | 07/21/2014 |
| NPI Last Update Date: | 07/21/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 5007011 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |