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General NPI Number Information
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NPI Number | 1013656792
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Entity Type | Organization
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Legal Business Name | LISE LLC
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Dates
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Enumeration Date | 06/01/2022
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Last Update Date | 06/05/2022
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Provider Practice Location Address
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Address Line | 370 DOOLITTLE RD
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City | WOODBURY
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State | TN
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Zip | 37190-1129
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Country | US
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Telephone | 877-743-2646
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Fax |
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Provider Business Mailing Address
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Address Line | 130 CINEMA DR APT 2112
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City | HENDERSONVILLE
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State | TN
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Zip | 37075-6397
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Country | US
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Telephone | 615-260-8829
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SEKOU MOLETTE
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Credential |
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Telephone | 615-260-8829
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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