Organization
JOIE DEVIVRE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LISA J JERRELLS MD (MD)
(812) 334-2772
Entity
Organization
Contact information
Practice address
1535 PIAZZA DRIVE, BLOOMINGTON, IN 47401
(812) 334-2772
Mailing address
1535 PIAZZA DRIVE, BLOOMINGTON, IN 47401
(812) 334-2772
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01052568A
IN
Other
Enumeration date
11/26/2008
Last updated
11/26/2008
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