Healthcare Provider Details

I. General information

NPI: 1760059356
Provider Name (Legal Business Name): LISA WARD RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2316 S CEDAR ST
LANSING MI
48910-3152
US

IV. Provider business mailing address

PO BOX 30161
LANSING MI
48909-7661
US

V. Phone/Fax

Practice location:
  • Phone: 517-887-4302
  • Fax: 517-887-4437
Mailing address:
  • Phone: 517-887-4302
  • Fax: 517-887-4437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2902013502
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: