| NPI | 1104122647 |
|---|---|
| Professional Name | LISA RENEE LACKEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NV 818418) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: NM CNP-01735) |
| Enumeration Date | 2011-02-01 |
| Last Update Date | 2020-01-31 |