Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 205023 | OK |
N | 363LA2200X | Nurse Practitioner - Adult Health | 205023 | OK |
N | 363LG0600X | Nurse Practitioner - Gerontology | 205023 | OK |
NPI | 1003582644 |
---|---|
Provider Name | Lisa Michele Gann |
First Address | Bixby, OK 74008-2124 |
Second Address | Tulsa, OK 74136-1902 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2021 |
Last Update Date | 23/08/2021 |