NPI | 1831123793 |
---|---|
Former Name | LISA M DIAMOND |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MA 187547) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CT 2355) |
Enumeration Date | 2006-07-10 |
Last Update Date | 2022-03-23 |