NERISSA LICUP

KINGSPORT, TN
NPI1720269731
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy207R00000X Internal Medicine
(Licence: TN  46416)
Additional Taxonomies390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date2007-11-19
Last Update Date2023-06-23
Business Address
Dr. NERISSA LICUP MD
2205 PAVILION DR STE 101
KINGSPORT, TN 37660-4641
Phone number: 423-392-6000
Mailing Address
Dr. NERISSA LICUP MD
2205 PAVILION DR STE 101
KINGSPORT, TN 37660-4641
Phone number: 423-392-6000