LISA DEPTULA

SOUTHAVEN, MS
NPI1184052508
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy390200000X Student in an Organized Health Care Education/Training Program
Additional Taxonomies363A00000X Physician Assistant
(Licence: CA  PA54017)
363A00000X Physician Assistant
(Licence: MI  5601006710)
Enumeration Date2013-10-22
Last Update Date2025-04-22
Business Address
LISA DEPTULA PA, MD
7601 SOUTHCREST PKWY
SOUTHAVEN, MS 38671-4739
Phone number: 662-772-3607
Mailing Address
LISA DEPTULA PA, MD
7601 SOUTHCREST PKWY
SOUTHAVEN, MS 38671-4739
Phone number: