Individual
LISA FARRER GILLETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10042 MULBERRY LN, GRAND BLANC, MI 48439-2535
(989) 513-0935
Mailing address
10042 MULBERRY LN, GRAND BLANC, MI 48439-2535
(989) 513-0972
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1124405873
—
MI
Enumeration date
05/01/2015
Last updated
03/06/2019
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