NPI | 1164400941 |
---|---|
Former Name | LISA PATRICE SULLIVAN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9270099) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IN 71002026A) |
Enumeration Date | 2006-01-03 |
Last Update Date | 2010-07-07 |