| NPI | 1992174007 |
|---|---|
| Former Name | LISA ELIZABETH CARROLL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 14025) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA60892491) |
| Enumeration Date | 2015-09-18 |
| Last Update Date | 2023-10-02 |