Individual
LISA CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2250 HICKORY RD, SUITE 240, PLYMOUTH MEETING, PA 19462-1047
(610) 834-1122
(610) 834-7525
Mailing address
6118 BELDEN ST, PHILADELPHIA, PA 19149-3234
(215) 288-5234
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN257684L
PR
Other
Enumeration date
05/31/2007
Last updated
07/08/2007
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