Healthcare Provider Details

I. General information

NPI: 1366353526
Provider Name (Legal Business Name): LISA JARUWANNAKORN BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1565 EGYPT PIKE
CHILLICOTHEE OH
45601-3974
US

IV. Provider business mailing address

1565 EGYPT PIKE
CHILLICOTHEE OH
45601-3974
US

V. Phone/Fax

Practice location:
  • Phone: 740-773-5211
  • Fax: 740-772-2974
Mailing address:
  • Phone: 740-773-5211
  • Fax: 740-772-2974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN.444706
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: