Individual
LISA HANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
424 E 4TH ST STE 100, ROYAL OAK, MI 48067-2757
(888) 854-1397
Mailing address
424 E 4TH ST STE 100, ROYAL OAK, MI 48067-2757
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704279694
MI
Other
Enumeration date
03/22/2018
Last updated
07/30/2021
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