Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 5060 | CT |
NPI | 1013295575 |
---|---|
Provider Name | Mrs. Lisa Garvey Harrison |
First Address | Norwich, CT 06360-2315 |
Second Address | Norwich, CT 06360-2315 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2011 |
Last Update Date | 31/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
008042013 | (05) | CT |