| NPI | 1013340629 |
|---|---|
| Former Name | LISA ANN COLE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085005553) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 2378) |
| 363A00000X Physician Assistant (Licence: IL 085-005553) | |
| Enumeration Date | 2013-08-19 |
| Last Update Date | 2023-03-07 |