Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | F001346-1 | NY |
NPI | 1013240290 |
---|---|
Provider Name | Mrs. Lisa G Preller |
First Address | Delmar, NY 12054-3306 |
Second Address | Delmar, NY 12054-3306 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2009 |
Last Update Date | 11/06/2021 |