Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 8465 | CT |
NPI | 1285286765 |
---|---|
Provider Name | Mrs. Laura Kathryn Lissner |
First Address | Alexandria, VA 22304-1920 |
Second Address | Hartford, CT 06106-3322 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2019 |
Last Update Date | 14/09/2019 |