Basic Information
| Provider Information | |||||||||
| NPI: | 1003083536 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LORD | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | D. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 840 OLD COUNTY HOME RD | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278569171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2524593100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 NASH MEDICAL ARTS MALL | ||||||||
| Address2: | |||||||||
| City: | ROCKY MOUNT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278041400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2524513100 | ||||||||
| FaxNumber: | 2524513141 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2008 | ||||||||
| LastUpdateDate: | 02/22/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 103067 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | P21267 | 01 | UPIN | OTHER |