Individual
MS. LISA M WOOTEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MT-BC
Contact information
Practice address
520 W 4TH ST, WILLIAMSPORT, PA 17701-6038
(570) 601-1630
(570) 601-1631
Mailing address
520 W 4TH ST, WILLIAMSPORT, PA 17701-6038
(570) 601-1630
(570) 601-1631
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
08632
GA
Other
Enumeration date
11/30/2010
Last updated
11/30/2010
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