Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | D0051619 | MD |
NPI | 1023083920 |
---|---|
Provider Name | Dr. Lisa Michelle Pierson |
First Address | Fort Campbell, KY 42223-5318 |
Second Address | Fort Campbell, KY 42223-5318 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
VAD000 | (02) | KY |