| NPI | 1942567979 |
|---|---|
| Former Name | LISA RAE MILLER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2004023623) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KS 75527) |
| Enumeration Date | 2012-04-16 |
| Last Update Date | 2016-05-03 |