Healthcare Provider Details

I. General information

NPI: 1811629595
Provider Name (Legal Business Name): LISA CHRISTINE LEPPALA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2022
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 W US HIGHWAY 2
WAKEFIELD MI
49968-9515
US

IV. Provider business mailing address

103 W US HIGHWAY 2
WAKEFIELD MI
49968-9515
US

V. Phone/Fax

Practice location:
  • Phone: 906-229-6120
  • Fax: 906-229-6191
Mailing address:
  • Phone: 906-229-6120
  • Fax: 906-229-6191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704232857
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: