Individual
NICOLAS WILLIAM LISOWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5177 MCCARTY LN, LAFAYETTE, IN 47905-8764
(765) 448-8100
Mailing address
5177 MCCARTY LN, LAFAYETTE, IN 47905-8764
(765) 448-8100
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
11023776A
IN
Other
Enumeration date
06/10/2024
Last updated
06/10/2024
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