| NPI | 1689072738 |
|---|---|
| Former Name | LISA DIANE SUROVICK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704147850) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 4714147850) |
| Enumeration Date | 2014-12-05 |
| Last Update Date | 2020-09-24 |