Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 244156 | OH |
N | 363LG0600X | Nurse Practitioner - Gerontology | 244156 | OH |
NPI | 1063815587 |
---|---|
Provider Name | Lisa Brown |
First Address | Westlake, OH 44145-2398 |
Second Address | Westlake, OH 44145-2398 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2014 |
Last Update Date | 20/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0112414 | (05) | OH |