Individual
MISS LISA GILMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPNP-AC
Contact information
Practice address
3959 BROADWAY, NEW YORK, NY 10032-1559
(212) 305-8458
Mailing address
1785 215TH ST, APT 17A, BAYSIDE, NY 11360-1727
(718) 428-4182
Taxonomy
Speciality
Code
Description
License number
State
363LP0222X
Critical Care Pediatric Nurse Practitioner
Primary
F380564
NY
Other
Enumeration date
03/30/2007
Last updated
07/08/2007
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