Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 5013906 | NC |
N | 363LW0102X | Nurse Practitioner - Women's Health | F420719 | NY |
NPI | 1023270972 |
---|---|
Provider Name | Ms. Lisa Anne Cooleen |
First Address | Wantagh, NY 11793-1231 |
Second Address | Winston Salem, NC 27157-5709 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2008 |
Last Update Date | 19/01/2021 |