Provider Demographics
NPI:1598901563
Name:COX, LISA CAROLYN
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:CAROLYN
Last Name:COX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30940 FOUR CORNER RD
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:IL
Mailing Address - Zip Code:62674-4506
Mailing Address - Country:US
Mailing Address - Phone:217-436-2198
Mailing Address - Fax:217-436-2198
Practice Address - Street 1:30940 FOUR CORNER RD
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:IL
Practice Address - Zip Code:62674-4506
Practice Address - Country:US
Practice Address - Phone:217-436-2198
Practice Address - Fax:217-436-2198
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-22
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist