Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 01086334A | IN |
N | 207VX0201X | Gynecologic Oncologist | 22924 | OK |
NPI | 1356456438 |
---|---|
Provider Name | Lisa M Landrum |
First Address | Indianapolis, IN 46219-4959 |
Second Address | Indianapolis, IN 46202-5116 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2006 |
Last Update Date | 14/02/2022 |