Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 1065521 | AL |
NPI | 1003891607 |
---|---|
Provider Name | Lisa Colette Ryan |
First Address | Tuscaloosa, AL 35406-1833 |
Second Address | Tuscaloosa, AL 35406-1833 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P37694 | (02) |