Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | CH11944 | FL |
NPI | 1083139240 |
---|---|
Provider Name | Dr. Lori Puskar |
First Address | Clearwater, FL 33755-4733 |
Second Address | Clearwater, FL 33755-4815 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2017 |
Last Update Date | 09/08/2017 |