Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 37680 | AZ |
NPI | 1326253444 |
---|---|
Provider Name | Lisa Coffey Oliver |
First Address | Cottonwood, AZ 86326-4602 |
Second Address | Cottonwood, AZ 86326-4602 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2007 |
Last Update Date | 05/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
456224 | (05) | AZ |