Healthcare Provider Details

I. General information

NPI: 1922587674
Provider Name (Legal Business Name): LISA CREECH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2018
Last Update Date: 08/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 BURNET AVE
CINCINNATI OH
45229-3014
US

IV. Provider business mailing address

946 WOODLYN DRIVE N
CINCINNATI OH
45230-4421
US

V. Phone/Fax

Practice location:
  • Phone: 513-357-2805
  • Fax: 513-357-2811
Mailing address:
  • Phone: 907-360-4996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRN.308981
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: