| NPI | 1548200512 |
|---|---|
| Former Name | LISA MARIE BALLOU |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209001259) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 2813-033) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2024-04-26 |