| NPI | 1720077134 |
|---|---|
| Former Name | LISA MICHELLE KING |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 9441597) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NC 201503) |
| 363LF0000X Nurse Practitioner, Family (Licence: SD CP000767) | |
| Enumeration Date | 2005-10-18 |
| Last Update Date | 2022-02-14 |