Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LW0102X | Nurse Practitioner - Women's Health | 2861872 | FL |
N | 363LX0001X | Nurse Practitioner - Obstetrics & Gynecology | 1609232 | FL |
NPI | 1083661169 |
---|---|
Provider Name | Lisa Dorner |
First Address | Bradenton, FL 34209-2314 |
Second Address | Bradenton, FL 34209-2314 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P29585 | (02) | FL |