Healthcare Provider Details

I. General information

NPI: 1386178648
Provider Name (Legal Business Name): LISA ANN TERRELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2017
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 N HEDGES ST
DAYTON OH
45403-1354
US

IV. Provider business mailing address

600 WAYNE AVE
DAYTON OH
45410-1122
US

V. Phone/Fax

Practice location:
  • Phone: 937-531-4195
  • Fax: 937-531-4200
Mailing address:
  • Phone: 937-496-2000
  • Fax: 937-463-2905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN 159092 M IV
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: