| NPI | 1255336160 |
|---|---|
| Former Name | LISA J. JERRELLS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: IN 01052568A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01052568A) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2016-05-23 |