Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 3008957 | KY |
NPI | 1003218140 |
---|---|
Provider Name | Celaida Lezcano |
First Address | Louisville, KY 40202-1901 |
Second Address | Louisville, KY 40202-1901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2014 |
Last Update Date | 23/10/2020 |