Individual
MISS LISA NICOLE PROUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
201 CHESTNUT AVE, ALTOONA, PA 16601-4927
(814) 946-5411
Mailing address
612 E MAIN ST # R, ROARING SPRING, PA 16673-1320
(814) 330-9591
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN283072
PA
Other
Enumeration date
03/22/2010
Last updated
03/22/2010
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