Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 4704243582 | MI |
NPI | 1003288226 |
---|---|
Provider Name | Dr. Lisa Marie Wargo |
First Address | Washington Township, MI 48094-3840 |
Second Address | Madison Heights, MI 48071-3487 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2015 |
Last Update Date | 27/10/2015 |