Individual
GINA LIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3775 BUSHMAN LAKE LN, ORTONVILLE, MI 48462-9240
(248) 310-7133
Mailing address
3775 BUSHMAN LAKE LN, ORTONVILLE, MI 48462-9240
(248) 310-7133
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
4704157099
MI
Other
Enumeration date
04/28/2015
Last updated
04/28/2015
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