| NPI | 1902497597 |
|---|---|
| Former Name | LACCEY LOUISE LISKA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IA A162720) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IA A162720) |
| Enumeration Date | 2021-01-27 |
| Last Update Date | 2022-03-04 |