Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 1-057454 | AL |
NPI | 1104955327 |
---|---|
Provider Name | Mrs. Lisa Webber Gore |
First Address | Fairhope, AL 36532-6971 |
Second Address | Mobile, AL 36604-3301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2007 |
Last Update Date | 08/07/2007 |