| NPI | 1326254046 |
|---|---|
| Former Name | LISA JEFFUS MOORE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 1307) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 001000182) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2015-03-17 |