Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | RN187814 NP | GA |
NPI | 1104019801 |
---|---|
Provider Name | Ms. Lisa Schlageter Stadalius |
First Address | Marietta, GA 30066-1542 |
Second Address | Kennesaw, GA 30144-5588 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2007 |
Last Update Date | 26/08/2007 |