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NPI Code Detail

MEDICARE: LISA ANN EVANS

MEDICARE:   LISA ANN EVANS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner022250OH

General Provider Information

NPI Number : 1083355820
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA ANN EVANS
Provider Business Mailing Address
First Line : 6872 JENNIFER LYNN DR
Second Line :
City : CINCINNATI
State : OH
Zip : 45248-2144
Country : US
Telephone Number : 859-466-9334
Fax Number :
Provider Business Practice Location Address
First Line : 3008 GLENMORE AVE
Second Line :
City : CINCINNATI
State : OH
Zip : 45238-2203
Country : US
Telephone Number : 859-466-9334
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2022
Last Update Date : 04/05/2022

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Directions to “ LISA ANN EVANS ” Practice Location

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