MEDICARE: LISA HOUGHTON

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
1	163WP0808X	Psychiatric/Mental Health Registered Nurse	4704179931	MI

General Provider Information

NPI Number	:	1174154678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA HOUGHTON

Provider Business Mailing Address
First Line	:	3369 MILES RD
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49201-8707
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3369 MILES RD
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49201-8707
Country	:	US
Telephone Number	:	517-962-4861
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2020
Last Update Date	:	02/03/2020

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Directions to “ LISA HOUGHTON ” Practice Location

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