Healthcare Provider Details

I. General information

NPI: 1942163381
Provider Name (Legal Business Name): LISA MARIE CAMERON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 KETTENRING DR
DEFIANCE OH
43512-1752
US

IV. Provider business mailing address

905 JOHNSON RD
PAULDING OH
45879-8944
US

V. Phone/Fax

Practice location:
  • Phone: 419-783-1311
  • Fax:
Mailing address:
  • Phone: 419-956-1243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: