Individual
ALLA LISOVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
530 S JACKSON ST, LOUISVILLE, KY 40202-1675
(502) 588-4600
Mailing address
PO BOX 909, LOUISVILLE, KY 40201-0909
(502) 588-4600
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
3013041
KY
363LF0000X
Family Nurse Practitioner
71011328A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100684220
—
KY
Enumeration date
05/03/2019
Last updated
01/13/2022
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