Individual
LISA MCKERN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
357 FOGGY LN, PORT ORANGE, FL 32129-7812
(386) 453-1430
Mailing address
357 FOGGY LN, PORT ORANGE, FL 32129-7812
(518) 331-3733
Taxonomy
Speciality
Code
Description
License number
State
372500000X
Chore Provider
—
FL
372600000X
Adult Companion
—
FL
376J00000X
Homemaker
Primary
—
FL
Other
Enumeration date
06/05/2016
Last updated
06/19/2016
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