| NPI | 1265029052 |
|---|---|
| Former Name | LISA JEAN MACOMBER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IA a161501) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: IA A161501) |
| Enumeration Date | 2020-12-28 |
| Last Update Date | 2022-05-18 |