Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003858507 |
---|---|
Provider Name | Lisa Elstun |
First Address | Cov, KY 41011-3717 |
Second Address | Florence, KY 41042-1553 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
184607 | MEDICARE GROUP NUMBER (01) | KY |