| 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 |