Individual
MR. LISA K AGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1100 W. 21ST, CLOVIS, NM 88101
(575) 769-2345
Mailing address
1100 W. 21ST, CLOVIS, NM 88101
(575) 769-2345
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
58384031
—
NM
Enumeration date
11/11/2016
Last updated
03/13/2019
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