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Individual
MRS. LISA M PLOCK
Active
Individual
MRS. LISA M PLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN075180
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000806649E
—
GA
01
—
581719867066
TRICARE
—
Enumeration date
10/12/2005
Last updated
07/07/2014
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