Individual
LISA HYDORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
47601 GRAND RIVER AVE, NOVI, MI 48374-1233
(248) 465-4249
Mailing address
30400 TELEGRAPH RD STE 405, BINGHAM FARMS, MI 48025-5817
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704289100
MI
Other
Enumeration date
01/07/2019
Last updated
01/07/2019
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