Individual
LISA KOOP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5050 N CLINTON ST, FORT WAYNE, IN 46825-5886
(260) 484-8551
Mailing address
5052 N CLINTON ST, FORT WAYNE, IN 46825-5822
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
28193681A
IN
Other
Enumeration date
08/11/2022
Last updated
08/11/2022
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