Healthcare Provider Details

I. General information

NPI: 1558636662
Provider Name (Legal Business Name): LISA STOKES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA ROSS

II. Dates (important events)

Enumeration Date: 03/22/2012
Last Update Date: 02/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4623 WESLEY AVE SUITE P
CINCINNATI OH
45212-2246
US

IV. Provider business mailing address

PO BOX 1239
TROY MI
48099-1239
US

V. Phone/Fax

Practice location:
  • Phone: 513-841-0777
  • Fax: 513-841-0877
Mailing address:
  • Phone: 248-824-6600
  • Fax: 248-324-1477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.13187-NP
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCOA.13187-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: