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General NPI Number Information
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NPI Number | 1043598485
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Entity Type | Individual
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Provider Name | LISA MARIE TOLLIVER PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/03/2011
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Last Update Date | 11/10/2021
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Provider Practice Location Address
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Address Line | 6276 COUNTY ROAD 107
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City | PROCTORVILLE
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State | OH
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Zip | 45669-8867
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Country | US
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Telephone | 888-221-1826
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 390
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City | HUNTINGTON
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State | WV
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Zip | 25708-0390
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Country | US
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Telephone | 304-429-1088
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Fax | 304-696-1623
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 2555
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 50.003489
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA1634
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License Number State | KY
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