Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 10796 | TN |
NPI | 1013974252 |
---|---|
Provider Name | Mrs. Lisa Suzanne Winters |
First Address | Chattanooga, TN 37421-5383 |
Second Address | Chattanooga, TN 37403-2103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2006 |
Last Update Date | 08/07/2007 |