Most Relevant Information
Provider Data
| NPI Number: | 1003577461 |
| Provider Name: | LISA LYNN DODGE |
| Entity Type: | Individual |
| Taxonomy Code: | 3747P1801X |
| Specialty: | Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 01/06/2022 |
| Last Updated: | 01/06/2022 |
Provider Practice Location
32 MADISON ST.
CHAPMANVILLE
WV
25508
Practice Location Phone/Fax
| Phone: | 7573341445 |
| Fax: |
Provider Mailing Location
32 MADISON ST.
CHAPMANVILLE
WV
25508
Provider Mailing Phone/Fax
| Phone: | 7573341445 |
| Fax: |