1700395092 NPI number — LISA WARD LPN

Table of content: LISA WARD LPN (NPI 1700395092)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700395092 NPI number — LISA WARD LPN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WARD
Provider First Name:
LISA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JOHNSON
Provider Other First Name:
LISA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1700395092
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
823 CATALINA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARION
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43302-6041
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
950 MEADOW DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT GILEAD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43338-1389
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-802-8398
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/29/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 164W00000X , with the licence number:  PN131198 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PN131198 . This is a "OHIO BOARD OF NURSING" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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