Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife |
NPI | 1043450844 |
---|---|
Provider Name | Mrs. Lisa Shea Gambini |
First Address | Honesdale, PA 18431-3144 |
Second Address | Honesdale, PA 18431-3144 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2009 |
Last Update Date | 15/02/2013 |