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Individual

MRS. MARIE LISE THEARD

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
10641 SW 126TH ST, MIAMI, FL 33176-4750
(305) 496-3154
Mailing address
10641 SW 126TH ST, MIAMI, FL 33176-4750
(305) 496-3154

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN5151268
FL

Other

Enumeration date
02/16/2016
Last updated
02/16/2016
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