NPI | 1053645770 |
---|---|
Former Name | LISA MARIE THOMPSON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: UT 6593775-3102) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: AK 130269) |
163W00000X Registered Nurse (Licence: UT 6593775-3102) | |
Enumeration Date | 2009-09-28 |
Last Update Date | 2024-10-17 |