Provider Demographics
NPI:1962748079
Name:RICCI, LISA LEIGH (PA-C)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:LEIGH
Last Name:RICCI
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:4402 SHIPYARD BLVD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6161
Mailing Address - Country:US
Mailing Address - Phone:910-452-1400
Mailing Address - Fax:910-332-1072
Practice Address - Street 1:5115 OLEANDER DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-7018
Practice Address - Country:US
Practice Address - Phone:910-362-1011
Practice Address - Fax:910-362-1012
Is Sole Proprietor?:No
Enumeration Date:2012-12-17
Last Update Date:2016-05-17
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Provider Licenses
StateLicense IDTaxonomies
NC0010-03981363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical