| NPI | 1164498929 |
|---|---|
| Former Name | LISA MARIE REYNOLDSRODRIGUEZ |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA 191178) |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2023-09-19 |