Doctor Name: | MRS. LISA MUNCH |
NPI Number: | 1033482195 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | N.P. |
License Number: | 2012005446 |
Business Practice Address: | 233 Clarkson Rd Ellisville, MO - 630112219 |
Business Phone Number: | 6362568644 |
Business Fax Number: | |
Mailing Address: | 233 Clarkson Rd, ELLISVILLE |
State: | MO |
Postal Code: | 630112219 |
Phone Number: | 6362568644 |
Fax Number: | |
NPI Enumeration Date: | 02/20/2012 |
NPI Last Update Date: | 02/20/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 2012005446 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |