| NPI | 1346226735 |
|---|---|
| Former Name | LISA C MAGNUS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 63272) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 43715) |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2021-02-02 |