| NPI | 1508220062 |
|---|---|
| Former Name | MARLISA ROSE HAWLEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI 4301116977) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2016-04-11 |
| Last Update Date | 2019-04-17 |