Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | RN087816 | GA |
NPI | 1003080789 |
---|---|
Provider Name | Resa A Lord |
First Address | Columbus, GA 31901-3500 |
Second Address | Columbus, GA 31901-3500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2008 |
Last Update Date | 15/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RN087816 | LICENSE (01) | GA |