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Individual

MARIANNE LISSADE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
AGNP-C

Contact information

Practice address
1825 ROCKBRIDGE RD STE 15B, STONE MOUNTAIN, GA 30087-3306
(470) 444-3134
(470) 276-4370
Mailing address
PO BOX 740015, ATLANTA, GA 30374-0015
(312) 733-9730

Taxonomy

Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
RN147281
GA
363LG0600X
Gerontology Nurse Practitioner
RN147281
GA

Other

Enumeration date
07/08/2016
Last updated
01/22/2024
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