Individual
DR. NERISSA LICUP
Active
Individual
DR. NERISSA LICUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
46416
TN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1521020
—
TN
05
—
1720269731
—
VA
01
—
4276956
BLUECARE
TN
01
—
P01015971
RR MEDICARE
TN
Enumeration date
11/19/2007
Last updated
06/10/2024
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