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Individual
MRS. LISA GENUALDI
Active
Individual
MRS. LISA GENUALDI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
209008616
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
APN LICENSE NUMBER
209008616
IL
Enumeration date
02/08/2011
Last updated
02/08/2011
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