| NPI | 1659434074 |
|---|---|
| Former Name | LISA GILLIAM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 13021) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 503871) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2020-11-12 |