Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 0429105 | KS |
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 2001006202 | MO |
NPI | 1003818345 |
---|---|
Provider Name | Dr. Lisa Marie Hermes |
First Address | Kansas City, MO 64111-3220 |
Second Address | Kansas City, MO 64111-3220 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2005 |
Last Update Date | 07/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100404340B | (05) | KS |
205318504 | (05) | MO |
H34634 | (02) |