Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 001108 | CT |
NPI | 1013368521 |
---|---|
Provider Name | Mrs. Lisa Jane Warren |
First Address | Stratford, CT 06615-7606 |
Second Address | New Haven, CT 06510-3220 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2016 |
Last Update Date | 27/06/2016 |