Individual
LISA D ANDERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
402 NEW YORK AVE, DOWAGIAC, MI 49047-1772
(269) 479-6043
Mailing address
402 NEW YORK AVE, DOWAGIAC, MI 49047-1772
(269) 479-6043
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703085995
MI
164W00000X
Licensed Practical Nurse
8352
WY
Other
Enumeration date
06/11/2018
Last updated
06/11/2018
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