Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 0101241828 | VA |
N | 2080P0204X | Pediatric Emergency Doctor | 46875 | WI |
NPI | 1235180993 |
---|---|
Provider Name | Dr. Lisa A Uherick |
First Address | Roanoke, VA 24014-1838 |
Second Address | Roanoke, VA 24014-1838 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2006 |
Last Update Date | 18/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009906261F | HUMANA (01) | |
34528000 | (05) | WI |
I20386 | (02) |