| NPI | 1619519469 |
|---|---|
| Former Name | LISA PETERSON HANEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 8739478-4405) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 8739478-3102) |
| Enumeration Date | 2019-10-14 |
| Last Update Date | 2019-12-11 |