Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | SP015813 | PA |
NPI | 1023133907 |
---|---|
Provider Name | Lisa D Ross |
First Address | Wayne, PA 19087-3924 |
Second Address | Wayne, PA 19087-3924 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2007 |
Last Update Date | 24/04/2020 |