Healthcare Provider Details

I. General information

NPI: 1225792757
Provider Name (Legal Business Name): LISA M NESLINE APRN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA M THOMAS

II. Dates (important events)

Enumeration Date: 10/31/2021
Last Update Date: 08/16/2022
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1949 W MARKET ST
AKRON OH
44313-6910
US

IV. Provider business mailing address

75 ARCH ST STE 301
AKRON OH
44304-1429
US

V. Phone/Fax

Practice location:
  • Phone: 330-867-5410
  • Fax:
Mailing address:
  • Phone: 330-253-1800
  • Fax: 330-253-3955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0029901
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: