NPI | 1518630060 |
---|---|
Former Name | LISSA SMITH |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: IN 71011270A) |
Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: IN 71011270A) |
Enumeration Date | 2021-07-30 |
Last Update Date | 2021-12-03 |