Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 381836 | NY |
NPI | 1043452261 |
---|---|
Provider Name | Lisa M Guan |
First Address | Flushing, NY 11355 |
Second Address | Flushing, NY 11355 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2009 |
Last Update Date | 02/04/2009 |