Provider Information for 1902116429
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LISA L TUTHILL MA
Other Names:Former Name:LISA L LOWRY MASex: Female
NPI: 1902116429
Last Updated: 2010-10-18
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1902116429 | ||||||||
| Enumeration Date | 2010-10-18 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | PO BOX 1304 LARAMIE, WY 82073-1304 United States Phone: 307-742-6222 | Fax:307-742-9905 | ||||||||
| Primary Practice Address | 1277 N 15TH ST LARAMIE, WY 82072-2343 United States Phone: 307-742-6222 | Fax:307-742-9905 | ||||||||
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