Healthcare Provider Details

I. General information

NPI: 1154739464
Provider Name (Legal Business Name): LISA MOYER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2014
Last Update Date: 07/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1597 BOB O LINK BND W
COLUMBUS OH
43229-5616
US

IV. Provider business mailing address

1597 BOB O LINK BND W
COLUMBUS OH
43229-5616
US

V. Phone/Fax

Practice location:
  • Phone: 614-678-2904
  • Fax: 614-372-5621
Mailing address:
  • Phone: 614-678-2904
  • Fax: 614-372-5621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number0072730
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: