| NPI | 1629530043 |
|---|---|
| Former Name | ALISA RENEE PONTARELLI |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209019075) |
| Enumeration Date | 2019-04-04 |
| Last Update Date | 2019-06-11 |